Louisville Medicine Volume 67, Issue 10 | Page 21

INTERSECTION OF DESIGN & MEDICINE accommodate transfers to and from wheelchairs, with space for certain equipment, such as a floor lift, which assists these transfers. Family, friends and social support need room to accompany the patient who wants them there. An extra set of ears can potentially improve medication compliance, comprehension of medical advice and therefore, health outcomes. The exam tables should be designed to accommodate patients with neurologic and musculoskeletal inju- ries, such as flat tables which are adjustable in height, so a patient can transfer themselves from their wheelchair and back when possible. If the patient doesn’t have adequate upper body strength for transfers due to a severe disabling injury or even shoulder or wrist arthritis, then a mechanical Hoyer lift is needed. A comprehensive physical exam translates to appropriate diagnosis and comprehensive care, and the design of our clinic allows this for patients in wheelchairs. Wide hallways are important where two wheelchairs can pass each other side-by-side safely. This allows for a cordial greeting, bringing a sense of normalcy, community and humanity, always fruitful for the mind, body and soul. The clinic design must consider the accommodation of engaged multidisciplinary care, in which several providers may enter a pa- tient’s exam room together to create a plan of care. This process could include coordination and collaboration among nurse navigators, physical and occupational therapists, physicians from other disci- plines, prosthetists, case managers and others. An additional point of view is incredibly beneficial for the patients and also the doctors. Patients greatly benefit from individualized, interdisciplinary care. When patients leave the clinic, convenient routes connecting the clinic to other accessible public and common-use spaces is helpful. For instance, in UofL Health Frazier Rehabilitation Institute, the inpatient rehabilitation hospital unit, the outpatient wellness and rehabilitation gyms, and the clinic, along with many other areas of the hospital are located in close proximity, which is extremely convenient for our patients using wheelchairs. Design of the clinic schedule is just as important as design of the clinic space. Because of functional limitations, patients with disabilities encounter multiple day-to-day challenges that some- times preclude them from meeting strict office hours. Getting to appointments early in the day for these patients may be difficult, as each task may take longer, including toileting, dressing, eating, and transfers in and out of a vehicle. Clinic accommodations would include afternoon appointment slots available and kind under- standing when an unexpected delay in arrival occurs for patients. Facilitating ease of vehicle parking and/or a valet parking option can also contribute to patients’ efficiency of getting to an appoint- ment. Thus, intentional design of clinic space and scheduling can improve patient satisfaction and therefore retention of patients with disabilities in your clinic. We recognize not all clinics have space and, quite frankly, finan- cial capacity for every exam room to meet all the needs required to care for a complex group of patients with disability including having a large exam room, wide hallways, and assistive devices to help move patients such as Hoyer lifts. However, maybe in future clinic designs, managers and administrators could assign one exam room and tailor it to the needs of these patients. Following the considerations outlined above would help make patients feel more comfortable, welcomed and safe. These design changes should be considered for all medical offices including primary care and all specialties. As we design these appropriate exam rooms, we should get advice from those with disabilities to delineate clearly their specific needs when they enter our offices. In addition, emulating our own clinic visit from a wheelchair level may help us better un- derstand the perspective of those with spinal cord injuries or other disabling diagnoses. So, we challenge us all to engage our patients with disability in design decisions, and even attempt to stroll a mile in their wheelchair, to help us take better care for our patients. References: 1. National Service Inclusion Project. “Basic Facts: People with Disabilities.” http://www.serviceandinclusion.org/index.php?page=basic 2. Disability Status: 2019 - Census 20002019 Brief (PDF)(Report). US Census Bureau. March 2003. 3. Access to medical care for individuals with mobility disabilities. https:// www.ada.gov/medcare_mobility_ta/medcare_ta.htm Dr. Nelson practices cancer rehabilitation medicine with UofL Physicians Restorative Neuroscience at UofL Health Frazier Rehabilitation and Neuroscience Center. Dr. Castillo practices spinal cord injury medicine with UofL Physicians Restorative Neuroscience at UofL Health Frazier Rehabilitation and Neuroscience Center. MARCH 2020 19