Optometric Management Tip # 334 - Wednesday, June 25, 2008
Exam Room Size and Function
A great way to increase productivity and patient flow in your practice is to add an exam room. Multiple exam rooms per doctor are a necessity for efficient delegation of clinical testing to your technician staff. Whether you are converting some existing office space into a new exam room or designing a floor plan for a completely new office, the size of the exam room is an important consideration.
I'm seeing a trend in office design that leads to smaller and smaller exam rooms. With the cost of office space at a premium, you naturally want to get as much functionality as you can from your space, but it's possible to go too small. Here are my thoughts on optimum room sizes.
The exam room
I'm defining this room as one that houses a traditional exam chair and stand with a phoroptor, acuity chart and slit lamp. Here are some considerations:
- Realize that you will spend a large portion of your life in these exam rooms. Make them comfortable and pleasant to work in.
- Patient perception matters and a room that's too tiny and cramped does not create the wow factor.
- The patient often has a guest that needs to be in the room also, so allow space for at least one side chair. This guest may be a parent, caregiver, interpreter or friend.
- Plan for space for a technician to sit and function as a scribe. Even if you don't currently use scribes, I would not build a new exam room without considering it for the future. The technician needs a small area out of the way of the patient's visual path and near the refraction desk or counter. She will need a small desk area to write on paper forms and access the computer keyboard, mouse and monitor for electronic records and images. There are many possibilities for computers, from laptops to tablet PCs to standard desktops with wireless keyboards and mice, but they all need some workspace. A corner of the room works well for the tech because I'd like her to stay in the background while the doctor is with the patient.
- Consider the location of the sink so it's near the exam chair but not in the way of the scribe or patient guest. The corner behind the exam chair and to the left (as you face the chair) often works well.
- The exam room door location can cause problems if the room is very small and it opens onto the technician or guest space.
- I like the refraction desk/counter to be about 30 to 32 inches high rather than the usual counter height of 36 inches. This allows more comfortable use of the desk while seated on a stool.
- I like to use a mirror system for the acuity chart and I strongly recommend digital visual acuity monitors over any projector. Long refracting lanes, to come close to the 20 foot distance for optical infinity, are simply a waste of space and the room proportion is not very pleasing.
- One could simply place the acuity monitor on the wall opposite the patient for direct viewing and reduce the size of the letters for proper calibration at that distance. I'm sure refractions done that way in a short room can still be quite accurate and the practitioner could add -.25 diopter if necessary to compensate for accommodation, but I prefer to use a mirror and obtain the long viewing distance. Only one mirror is needed with this setup. The acuity chart (monitor) is placed on the wall behind the patient, usually high and to the left. A refraction mirror is placed on the wall directly in front of the patient (when they look through the phoroptor). This mirror has angling screws that cause the chart to be seen as perfectly centered in the mirror.
I have found an exam room that is 10 feet wide and 14 feet long to be luxuriously large while not wasteful. The smallest exam room I recommend is 8 X 12 feet. Any dimensions between those will work fine and it's certainly possible to go smaller with some limitations on the points made above.
The pretest room
Pretest and special test rooms are as important as exam rooms in the design of your clinical area. With new advanced instrumentation, we need more of these data collection spaces than ever before.
- Pretest rooms can work with many different room sizes, but they are usually not larger than 10 feet by 12 feet. 8 X 10 works well for three instruments on a power table.
- A side stool for a caregiver is nice to have, but not a requirement.
- Wall hooks for coats and purses are handy.
- Even though pretest equipment is expensive, if you're fortunate enough to have strong patient flow and more than four exam rooms, you will want two pretest rooms plus additional special testing rooms.
- Very small rooms, such as 6 feet by 10 feet, can work well for single purpose testing like visual fields or nerve fiber analysis. It is sometimes an advantage to have only one instrument in a room because it opens up quicker for the next patient.
- In large areas, it's possible to have two different patients being tested by two technicians on different instruments. It is distracting when the other people are speaking, however, and it can be awkward when it is time to switch instruments. I prefer to design pretest rooms for one patient at a time.
- Don't forget that the technician can perform some pretesting in an unused exam room, vacating the pretest room so the next patient has access.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management