Focus: Some Privacy, Please

July 20, 2009

Designing health care facilities for HIPAA compliance, while challenging, is essential to effective caregiving and patient privacy.

The goal of any successful health care project is to build highly efficient buildings where medical staff can deliver excellent care to patients, and to create an environment that is appealing and comfortable for patients, visitors and medical staff. In addition to these primary objectives, creating an environment that meets or exceeds the Health Insurance Portability and Accessibility Act of 1996 (HIPAA) oral privacy standards not only makes legal sense, it communicates to patients how important it is to protect their privacy.

HIPAA regulations address the security and privacy of “protected health information” (PHI), with an emphasis on acoustical privacy to safeguard confidential conversations and visual privacy of a patient’s medical records. While creating successful acoustic environments can be challenging, regular sound assessments and acoustical maintenance of equipment are essential to maintaining an auditory environment that promotes the effectiveness of caregivers as well as patient rest and healing.

HIPAA requires that health care entities take “reasonable safeguards” to ensure speech privacy, including administrative, technical and physical measures. These standards have importantly affected health care design. We can see the results in many areas of a hospital, including registration, nurses’ workstations, pharmacy, medical records, patient check-in, and consultation rooms, among others. Hospitals need a balance between the openness that will make patients and family members feel welcome and the security that ensures their privacy. Striking this delicate balance requires careful pre-design programming.

Health care designers are now programming and planning for required square footage to provide more private spaces during a patient’s hospitalization. The location of nurses’ stations is an important design consideration. In the past, hospitals favored the use of centralized nurses’ stations as the norm. These arrangements generated increased traffic and resulted in excess noise, ultimately reducing the time spent with patients. As a result, more decentralized units are being integrated into the design of these facilities, allowing patient visibility and supervision, but also making it easier to discuss a patient’s records without others hearing the private details. For example, windows for patient observation can be situated in satellite nursing stations to allow patient supervision at all times while the patient room door can remain closed. Instead of holding meetings in open corridors, designated support areas and private alcoves can also be created for this purpose with corners that block the sound from being transmitted to adjacent spaces. Individual pods with electronic charting can be used to hold conversations between nurses and family members.

Well-planned wayfinding that creates simple and direct routes of circulation for visitors can also prevent accidental entry into other functional areas where privacy may be a concern. Separation of emergency entrances and visitor walk-in areas can be achieved through physical barriers that can also improve wayfinding.

Noise levels are obviously much lower in single-bed rooms than in shared rooms or bays. In new hospital construction, there is already a trend toward standardizing single-bed private rooms. Shared patient rooms are being replaced by private patient rooms with family and caregiver zones to increase operational efficiency.

Through the use of effective interior building materials and finishes, design can further promote privacy. These finishes can absorb and mitigate noise to ensure patient confidentiality. Whenever possible, absorbent material should be placed close to the noise source. It should be integrated into large open areas to reduce the reverberation that might develop.

High-performance acoustical ceiling products, for example, can absorb sound and excess noise in both open and closed plan spaces. Ceiling panels made of mineral fiber or fiber glass are widely used for their inherent acoustical properties. Perforated wood ceiling panels are also ideal for this use because as noise travels, it gets trapped in the perforations, preventing the sound from traveling back into the space.

Material selection for floors, walls and furniture must also be taken into account as an attenuation factor in meeting HIPAA requirements. While carpets may be less desirable than non-porous surfaces in infection control environments, they can be very helpful in diffusing conversations in waiting areas and physicians’ offices. Acoustical fabric-wrapped wall panels can be used in open public spaces, like registration and waiting areas, and absorptive insulation can be placed above soffits and specialized acoustical clouds. Furthermore, upholstered furniture, bed coverings, window treatments, including elements like drapes and window valances, are natural noise-filtering materials. To help further ensure speech privacy, a sound-masking system can be specified in key areas to make conversations more difficult to comprehend.

The combination of these design elements will provide successful noise reduction in health care environments while respecting a patient’s right to privacy.

Ana Maria Valle is an interior designer with Coral Gables-based MGE Architects. MGE provides architecture, master planning and interior design services for health care, educational, and transportation projects in Florida and the Southeast. Headquartered in Coral Gables, FL, the firm has completed more than 500 high-profile projects since 1982.

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