31 How Patient Preference Can Affect Hospital Room Design And Mitigate Fall Risk

Faculty Mentor: Peter Fino (Health and Kinesiology, University of Utah)

Introduction

Hospital room design plays a crucial role in patient mobility, navigation, and fall prevention. Individuals interact differently with their surroundings, and these interactions can influence both perceived safety and ease of movement within a patient’s room.^[1] Key environmental factors, such as door type, room layout, and IV pole maneuverability, may significantly influence perceived safety and movement efficiency.^[2] Although prior studies rely on computational approaches to evaluate room design, a participant-centered approach remains under-explored.^[3] By directly engaging individuals who navigate these environments, we may gain deeper insight into how specific design features influence user experience. This study aimed to address this gap by collecting participant rankings and perceptions of door type (swinging vs. sliding) and room configuration (headwall vs. footwall) based on real-world navigation. This data complements biomechanical mobility measures from a separate analysis. This approach helps to better understand how to optimize hospital room layouts for patient safety and mobility.

Methods

A total of 18 participants (10 male, 8 female) who could walk independently were recruited with mean (SD) age, height, weight, and gait speed of 74.3 (4.2) years, 174.1 (8.9) cm, 84.4 (19.8) kg, and 0.97 (0.22) m/s, respectively. Before testing, participants’ gait speed and Timed Up-and-Go (TUG) time were measured. Participants navigated four hospital room layouts (Figure 1) in a randomized order, each featuring different door types (sliding vs. swinging) and room layout (headwall vs footwall), for a total of 16 trials (4 trials/layout). Each trial began with the participants sitting on the bed. After navigating to the bathroom door and opening it, participants shut the door, sat on the toilet, simulated handwashing in the sink, opened the door, and returned to bed. Participants completed trials with and without an IV pole to assess its impact on navigation. After each block (4 trials of the same layout), participants rated their perceived difficulty of navigating the room using the Rating Scale of Mental Effort (RSME, 0-150). After completing all 16 trials, the participants were given pictures of all room layouts to rank them from 1 (best) to 4 (worst). Based on their top two ranked configurations, participants were categorized as having a strong preference for the door type, the room layout, or neither. Door preference was further classified as swinging vs. sliding, while layout preference was classified as headwall vs. footwall. Tertiary layout preferences were then identified for participants grouped by door type or layout preference. TUG times and gait speed were then examined across these three preference categories. Descriptive statistics for TUG and gait speed were calculated for each group (sliding vs. swinging door and headwall vs. footwall layouts) based on the configuration they ranked first. The study was approved by the University of Utah Institutional Review Board, and informed consent was obtained prior to participation.

Results & Discussion

Based on the top two ranked configurations of the 18 participants, 10 preferred the door type, 5 the layout, and 3 had no strong preference (mean (SD) TUG time: 13.29 (2.54), 18.4 (6.83), and 17.29 (6.01) s, gait speed: 0.92 (0.16), 1.01 (0.18), and 1.18 (0.38) m/s, respectively). More participants favoured the door, so they were subdivided into swinging (n = 7) and sliding (n = 3) preferences (TUG: 13.99 (2.58) vs 11.65 (1.84) s; gait speed: 0.96 (0.16) vs. 0.82 (0.15) m/s). Among those preferring swinging doors, 5 chose headwall and 2 preferred footwall layout (TUG:14.09 (2.96) vs. 13.74 (2.14) s; gait speed: 0.92 (0.17) vs. 1.07 (0.03) m/s). Based on the participants’ first ranked configuration, 11 favoured swinging doors, 6 sliding doors, 12 favoured headwall, and 5 favoured footwall (TUG: 15.38 (4.97), 13.43 (3.58), 13.88 (3.3), 17.43 (7.16) s; gait speed: 0.95 (0.15), 0.97 (0.26), 0.9 (0.19), 1.08 (0.12) m/s). Meanwhile, the perceived difficulty of each configuration (sliding/headwall, sliding/footwall, swinging/headwall, and swinging/footwall) was reflected by mean RSME scores (SD) of 24.61 (18.37), 25.39 (16.6), 25.17 (22.58), and 29.72 (19.2), respectively. Overall, participants tended to prioritize door over layout, favouring swinging over sliding door, and headwall over footwall layouts.

Significance

These findings illustrate that participant preferences do not necessarily align with mobility and speed tests, highlighting the importance of patient perception playing a vital role in enhancing hospital design to reduce fall risk.

Acknowledgments

Funding from AHRQ R18HS025606 and the University of Utah Undergraduate Research Opportunity Program. We would like to thank Christina Geisler, Cecilia Monoli, Zach Barker, and Zachary Olson for their assistance throughout the study.