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TABLE (TABLE AND BED LABORATORY EXPERIMENT) TRIAL: A RANDOMIZED CONTROLLED TRIAL OF CONSULTATION ROOM LAYOUTS.
Ajiboye, Folaranmi
Ajiboye, Folaranmi
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Abstract
Abstract OBJECTIVE: The outpatient consultation room remains unchanged despite increasing use of technology mediated information sharing in the clinical encounter. The growth of outpatient medical care makes outpatient facilities the primary point of healthcare contact for many Americans. We propose implementing an adaptive design that supports a patient-centered approach to care. STUDY DESIGN: A randomized control trial conducted at the University of Kansas School of Medicine (KUSM) internal medicine resident clinic in Wichita, Kansas. METHODS: Fifty-nine patients were randomly assigned to consultation in a traditional room (n = 33) with a rectangular shaped examination table or in an experimental room (n = 26) with a round pedestal table. The care offered by the physician was not affected; however, room layouts and strategic placement of the laptop computer were different for both groups. Physicians did not have access to the survey. Patients completed a 5-point Likert scale post-visit questionnaire. The key features of this program were: a newly redesigned (experimental) consultation room featuring a round pedestal table in the experimental room allowing for a sitting style that enhances good proximity between the physician, patient and the computer screen used in information sharing during the visit; and a traditional room, featuring a rectangular padded examination table. All other features in the room layout were the same including room size, sink location, and number of seats in the room. Wilcoxon rank sum test was used to assess the combination score on each domain between the intervention and control group. The questionnaire was broken into domains with calculated response scores within each domain scaled from 0 to 100. RESULTS: A statistically significant difference in interpersonal-room interaction was found between the experimental room (65.24 ± 17.25) versus the traditional room (49.12 ± 22.35) scores (P = 0.0038). A higher percentage of participants in the experimental room reported their ability "to look at the information on the computer screen at any time they wanted" (24% vs. 12.9%) compared with the control group. More participants indicated that "provider shared information on the computer screen" for the experimental room (54.2% vs. 22.6%) than in the traditional room. Over half of subjects (72%) in the experimental room compared to the traditional room (40.6%) indicated complete agreement to "provider's engaging them in conversation about the information in the monitor". Patients reported that they were "able to look at the internet with the provider" with a total agreement response of 32% among the experimental room compared to 9.7% in the control group. There was no difference in patient satisfaction (P = 0.5524), mutual respect and communication quality (P = 0.8288), people-room interaction (P = 0.5892), or trust in physician (P = 0.5892). CONCLUSION: Changing the layout of a consultation room has the potential to improve information sharing. Clinicians who are interested in maximizing the benefits of their clinical encounter could consider changing the layout of their consultation room, especially the positioning of the computer screen.
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Date
2013-12-31
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University of Kansas
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Keywords
Public health, Medicine, Social research, Clinical encounter, Consultation room layout, Electronic health records, Interpersonal-room interaction, Patient-physician communication, Patient satisfaction