Active design of stroke unit aids patient recovery

Royal Melbourne Hospital’s new stroke unit offers a new time-critical, high-intervention rehabilitation treatment. Designers used biophilic principles and a central ‘racetrack’ to get stroke patients active within 24 hours. The impact on recovery, cost and staff satisfaction has been profound.

Stroke is one of Australia’s major causes of death and disability, but an exciting new treatment called endovascular clot retrieval (ECR) is having a major impact on patient outcomes. The time-critical, technically challenging, high-intervention rehabilitation treatment starts within 24 hours of clot removal.

The latest research shows the greatest benefits of ECR are achieved when blood flow is restored early, so getting short-term, high-needs patients up and active early is crucial.

ClarkeHopkinsClarke architects has quite literally designed Royal Melbourne Hospital’s new Stroke and Neurology Unit around this high-impact new approach. Project Architect Nicholas Simmonds said the bespoke facility uses biophilic design features including abundant natural light, soft curved forms, timber joinery and rug-like floor features, serene blue and warm grey seating upholstery and feature walls, and cosy nooks where staff, patients and visitors can interact and clinicians can observe incidental rehab activities or write up clinical notes. The effect is a calming, informal interior with elements of home, which naturally supports brain stimulation, physical activity and social connectivity.

“The environment needs to strike just the right balance in terms of stimulation,” Simmonds said.

“If a stroke patient is overstimulated, that can send them into stroke again.

The Racetrack

Patient rooms are located around the outside of the unit to capture natural light — a natural brain stimulant that aids recovery. Previously decentralised rehabilitation services and new clinical and caregiver support facilities are accommodated in a central hub. Rooms and rehab are linked by a wide circular walkway dubbed ‘The Racetrack’. This light-filled, sociable space is lined with upholstered timber joinery seating.

Staff, patients and visitors have embraced The Racetrack for all kinds of interactions and incidental rehabilitation: short walks, frequent rests, family visits, impromptu meetings — even companionable sessions where patients sit together working on brain-stimulating puzzles.

ClarkeHopkinsClarke Heath Partner Justin Littlefield said The Racetrack gives staff clear sightlines and subtle wall and floor markers to help unobtrusively monitor patients’ progress.

“Initially a patient might get up from a room opposite and just walk across the corridor,” he said. “Later they might take shortcuts through the middle — there’s another seat on the opposite side of this central zone, so there’s another 20 steps or so that gets them to the next spot. Eventually they might go for a whole loop of one of these ends, which all vary in distance. We actually had a lot of fun designing for these changing needs.”

ECR requires high patient–staff ratios akin to intensive care. The new unit decentralises clinical staff, locating a small staff workbench outside a pair of patient rooms to enable constant oversight and frequent interaction. Operable glazed walls and windows in high-dependency unit bedrooms can be switched from clear to opaque when privacy is required.

The design improves links to other departments, introduces teaching, training and research facilities that support patient care and staff development, and includes a higher proportion of single-bed patient rooms.

Patient satisfaction and recovery speed

Professor Mark Parsons, RMH Director of Neurology and head of the new Stroke Unit, said the design is having a “massive” impact on patient recovery and satisfaction.

“The old ward was really 19th-century design and now we’ve moved well into the 21st century.

“There’s lots of evidence that if you deprive stroke patients of a nice environment they actually recover more slowly. What we call an enriched environment, with lots of stimulation and activity, stimulates the brain to form new connections.

“We’re seeing patient satisfaction surveys of over 90% each month, and more stroke patients being discharged directly home who would previously have had to go on to rehabilitation.

“For the same length of stay, patients have a much better level of function than they did previously. They’re able to go home and look after themselves, rather than need further rehabilitation to get them to an independent level,” Professor Parsons said.

Happier patients and better recovery are producing huge savings for the hospital and the broader community, according to Professor Parsons.

“If you save one stroke patient from going to a nursing home, you’re saving the community around $200,000 in the first year and $100,000 thereafter.

“You would only need to prevent 10 patients a year from going to a nursing home to cover the cost of the ward. I think that’s a wonderful investment.”

Satisfied staff

Staff satisfaction has also increased with the new design. More appealing, less clinical-looking spaces to walk, meet and rest are motivating patients to stay active throughout their stay. Centralised rehabilitation services mean that valuable recovery time is no longer lost as staff shuttle patients to other departments.

Ward Clerk Mavi Whitton conceded that staff do more walking on the new ward but said they recognise the health benefits of that and appreciate the clear sightlines, natural light and touches of home like lovely timber joinery.

“For staff, this ward is much quieter and we feel a lot more connected,” she said.

“We seem to be able to see each other and communicate better. Patients love the rooms. They love the light. And they love the clean spaces we’ve got. It’s beautiful.”

Images credit: Rhiannon Slatter.