Hospital Unit Design Study: Carts vs. In-Room Workstations

Hospital-unit layout influences how far nurses travel to retrieve medications, document care and move between patient rooms. Excess travel can consume time that could otherwise support patient care and may contribute to physical fatigue.

A Rapid Modeling hospital-unit design study compared four workflow scenarios using Layout-iQ, Rapid Modeling Corporation’s workflow modeling engine. The software combined an industrial-engineering workflow database with a CAD drawing and calculated the total distance nurses would travel under specified assumptions.

The model compared centralized medication and documentation processes, two computer-cart workflows and in-room Proximity Systems workstations containing information technology, secured patient medications, supplies and medical equipment.

Study purpose and modeled factors

The study was designed to produce a quantitative comparison of hospital-unit layouts for medication and documentation workflows. It considered:

• Medication location.
• Documentation-equipment location.
• A typical number of medication cycles per day.
• Central nursing-station travel.
• Central pharmacy and unit-medication replenishment.
• Computer-cart storage and retrieval.
• In-room documentation and medication preparation.

Layout-iQ calculated walking distance in feet for each modeled design.

Scenario 1: central nursing station and central medications

The first scenario served as the baseline. It modeled three processes.

Medication administration

Medications were administered six times per day. The model assumed that the nurse began at the central station 50% of the time and in a patient room 50% of the time. From either starting point, the nurse traveled to the central medication location to retrieve and prepare the medication, then went to the patient room to administer it and returned to the central nursing station to document the event.

Medication replenishment

The unit’s medication supply was replenished once per day, including travel to and from a central pharmacy.

Documentation

Specific events were documented 12 times per day, requiring travel between patient rooms and the central nursing station.

Modeled result

45,406 feet of nurse travel per day.

Scenario 2: computer carts with a 50/50 storage factor

The second scenario modeled four processes using computer carts on a conservative storage-and-retrieval basis.

Medication administration and cart movement

Medications were administered six times per day. The model assumed that 50% of the time the nurse began at the central station and traveled to central cart storage to retrieve a cart. The other 50% of the time, the nurse moved directly from one patient room to another with the cart.

Cart medication replenishment

The medication supply on the cart was replenished three times per day, including travel between central cart storage and the unit’s central medication point.

Unit replenishment

The unit’s medication supply was replenished once per day with travel to and from the central pharmacy.

Documentation

Specific events were documented 12 times per day. Travel was split evenly between room-to-room movement and travel between patient rooms and central cart storage for retrieval and return.

Modeled result

37,892 feet of nurse travel per day.

Scenario 3: computer carts with an 80/20 storage factor

The third scenario represented a more optimistic computer-cart workflow. It used the same four process categories as Scenario 2 but assumed the cart was already available for room-to-room travel 80% of the time. Travel to central cart storage occurred only 20% of the time.

Modeled result

16,796 feet of nurse travel per day.

This was the best modeled outcome for the cart alternatives.

Scenario 4: in-room Proximity Systems workstations

The fourth scenario placed computer technology, medical equipment, secured patient medications and supplies at the point of care.

Medication administration

Medications were administered six times per day. The nurse was assumed to begin at the central station 50% of the time and in a patient room 50% of the time. Once in the applicable room, the nurse prepared, administered and documented the medication event at the in-room workstation.

Workstation medication replenishment

The medication supply in each workstation was replenished once per day, accounting for travel between patient rooms and the unit’s central medication supply.

Unit replenishment

The unit’s central medication supply was replenished once per day with travel to and from the central pharmacy.

Documentation

Specific events were documented 12 times per day at the workstation in the applicable patient room.

Modeled result

8,387 feet of nurse travel per day.

Results comparison

Scenario	Modeled distance per day	Difference from central baseline	Approximate reduction from baseline
Central nursing station and central medications	45,406 ft	Baseline	Baseline
Computer carts, 50/50 storage factor	37,892 ft	7,514 ft less	16.5%
Computer carts, 80/20 storage factor	16,796 ft	28,610 ft less	63.0%
In-room Proximity Systems workstations	8,387 ft	37,019 ft less	81.5%

Under the model’s assumptions, in-room workstations produced:

• Approximately half the travel of the optimistic computer-cart scenario.
• Less than one-quarter of the travel of the conservative computer-cart scenario.
• Less than one-fifth of the travel of the centralized baseline.

The original document characterizes these relationships as at least two times more efficient than the optimistic cart scenario, four times more efficient than the conservative cart scenario and six times more efficient than the central-station scenario.

What the model suggests for hospital planners

The study suggests that colocating medication preparation, documentation technology and appropriate supplies in or near patient rooms can reduce travel created by centralized processes. Its practical implications include:

• Map the complete medication and documentation workflow, not just room-to-room travel.
• Include cart retrieval, return and replenishment in comparisons.
• Model both typical and best-case cart availability.
• Account for central-pharmacy and unit-supply replenishment.
• Evaluate whether documentation can be completed in the patient room.
• Use the actual unit drawing and local activity data before making a capital decision.

Limitations and validation needed

Before using the model as evidence for a specific project, confirm or reproduce the analysis with current facility data. Important missing details include:

• Hospital and unit identity.
• Unit layout and number of rooms.
• Nurse staffing and assignment model.
• Number of modeled patients.
• Shift length and whether results represent one shift or 24 hours.
• Medication-cycle assumptions by unit type.
• Time spent at each destination.
• Walking speed and congestion.
• Cart downtime, charging and availability.
• Accessibility, infection-control and medication-security constraints.
• Independent validation or peer review of the model.

The model measures travel distance, not documentation quality, medication errors, patient outcomes, nurse retention or financial return. Those outcomes require separate evidence.

Using workflow modeling in hospital design

The strongest application of this case study is as a planning framework. Hospitals can use their own CAD drawings, observation data and clinical assumptions to compare alternatives before construction or deployment.

A current workflow study should:

1. Observe real nursing routes and task frequencies.
2. Document the location of medications, supplies, computers and patient rooms.
3. Build alternative layouts using the same workload assumptions.
4. Test conservative and optimistic operational conditions.
5. Compare travel distance, task time and equipment availability.
6. Review results with nurses, pharmacy, IT, facilities and infection prevention.
7. Pilot the preferred configuration and measure actual outcomes.

Bringing information and supplies closer to care

In this Rapid Modeling analysis, the in-room workstation scenario generated the shortest modeled nursing travel distance. The result supports further evaluation of decentralized documentation and medication workflows, but it should be treated as a scenario-specific model rather than a guarantee.

For hospitals considering a new unit or renovation, the next step is to model the actual floor plan and workflow with local data, then configure workstations around the selected care process.