Consultation Room Design and the Clinical Encounter: The Space and Interaction Randomized Trial

Abstract

Objective: The design of the consultation room remains largely unaltered despite major changes in clinical practice, such as the electronic medical record and patient-centered care. The value of redesigning the consultation room to accommodate these changes and the effect of a redesign on patient-clinician interaction are unclear. Methods: The authors randomly allocated 65 patient-physician dyads to consultations in a standard room ( n = 30) or in an experimental room designed with a semicircular table around which the clinician and the patient sat, with equal access to the computer screen ( n = 35). Participant responses to post-visit surveys, assessing patient experiences in these rooms, were compared in an intention-to-treat fashion. Results: The authors found no differences between the rooms in terms of patient satisfaction with the consultation, mutual respect, or communication quality. Compared to the standard room, patients in the experimental room were better able to interact with the computer monitor (24 [75%] vs. 17 [59%], P = 0.07) and had a greater ability to look at the screen at any time (22 [73%] vs. 8 [28%], P < 0.001); and they reported that clinicians allowed them to review the medical record on the screen (22 [71%] vs. 13 [45%], P = 0.012), shared information on the computer screen (24 [80%] vs. 18 [60%], P = 0.037), and reviewed information on the Internet with the patient (13 [43%] vs. 7 [26%], P = 0.010) more than those in the standard room. Conclusions: The design of the consultation room affects the clinical encounter. In particular, ready access to a computer screen using the electronic medical record and the Internet may enhance information sharing.