Providing vital information to patients & staff

Imagine a frosty February morning. It is -8°C and you arrive in shock at an unfamiliar hospital complex. The ambulance you tried to follow has long disappeared with your partner who has just suffered a heart attack at home. This is just one occasion, when you need clear, easy to read, informative hospital signage. Where can you park the car and when you have, how do you find the patient? I was lucky, a passing nurse on their way to work, realised my dilemma and helped me. But with good hospital signage you don’t need to be in the right place at the right time – you should be able to see at a quick glance exactly where to go.
    
Outside the hospital you need signs that are well lit and can be seen clearly from the main road. It’s essential that directions to the Emergency Department are eye catching – some hospitals paint the road outside it red, indicating where ambulances can park but not the general public. Good traffic management should ensure that patients and relatives approaching the Emergency Department by car are guided to an appropriate car park. Areas such as accident and emergency can benefit from signage that helps to keep patients and their relatives calm. For example, one of the frustrations in accident and emergency is wondering how long you have to wait. A large diagram on the wall showing a patient’s journey through the Emergency Department can be useful.

Lead the way
Inside the hospital, it is also useful to have different coloured paths painted on walls or floors so that patients and visitors do not get confused by corridors, which look similar. Signage also has to be suitable for the patient. For example, Great Ormond Street Hospital has been designed to be appealing to children. Animal characters are used to designate areas within the hospital, show visitors the way and at the same time entertain the children.
    
For hospitals within the National Health Service there are guidelines available at www.nhsidentity.nhs.uk/all-guidelines. These specify the corporate typeface (Frutiger or Arial), use of the NHS logo and tips such as the fact that using all upper case letters makes signs more difficult to read. When deciding what size the letters should be, it’s important to take into account how far away they need to be in order to be read and also the fact that they need to be accessible to everyone – including wheelchair users. Braille signs will be needed for those with impaired vision and are normally positioned underneath the standard text. There is also advice on where signs should be mounted and how high from the floor they should be (normally 60 inches/152 cm from the floor to the centre of the sign). It’s also important to ensure that letters and symbols contrast well with their background to improve legibility.

What Language?
If services are to be truly accessible to everyone, then depending on the region, it may be important for signs to be in more than one language. If so, it is important to take into account the degree that the signage reflects the population, which parts of the hospital need to have bilingual signs and the degree to which the translated text in each language is equivalent to the source text. An example of hospital signage in a Jerusalem hospital where there had been wrong lexical choices led to slight variations such as ‘premature baby clinic’ being signed as the ‘new born clinic’. This highlights the need for good quality control in translation and the acknowledgment that sometimes it is not possible to provide a true equivalent translation.
    
An alternative is to provide pictograms. Pictograms are symbols illustrating what is located in the area identified on the sign. There is usually a written description directly below the symbol. Pictograms can also be used to communicate health and safety information. IOSH-sponsored research found that pictorial materials improved understanding in migrant workers in the construction sector.

Categorising signage    
Health and safety signage at the hospital will be required if there is a significant risk that can’t be avoided or controlled in any other way, such as through safe systems of work or engineering controls. These signs are divided into five categories.
    
The first of these categories is prohibitory signs, which are round and have red edging, for example ‘No Smoking’ signs. Additionally, warning signs, which are yellow outlined in black, for example ‘Radioactive material’, form a second category.
    
Mandatory signs, which are round with a blue background, for example ‘Pedestrians must use this route’, are categorised accordingly. Emergency escape and first aid signs are rectangular or square and have a green background. An example of this sign is one with a white arrow indicating the way to take in an emergency.
    
Finally, fire-fighting signs, which are also rectangular or square but have a red background, are categorised separately.
    
Other signs can also be used to indicate unsafe conditions – such as wet floors. These and trailing cables are a cause of many slip and trip accidents. General housekeeping is important and planning cleaning work to avoid times when corridors are busiest is sensible.
    
It is not sufficient to rely on a sign to make an area safe. When staff and visitors are preoccupied or in a hurry, they may not notice signs indicating a wet floor or may ignore them or even remove them. Another area of accident prevention is to keep pedestrians and traffic well segregated and this is where clear road traffic signs and mandatory signs for pedestrians are paramount.

Digital signage
Traditionally hospital signs were made of plastic and the advantage of this material is that it is hard wearing and can be in many colours. However, one sign always displays the same information. The advantage of new digital signage is that it can provide up to date relevant information. In practice most hospitals use a combination of both. Digital signage can be used to let patients know how long they will have to wait in a clinic, how many car parking spaces are left but can also be used to broadcast messages about healthy behaviours or even show calming landscape pictures. There are now products available that can be uploaded with information and a schedule of what to play at different times. This information can be sent to the digital displays over the computer network, although this needs to be scheduled at a time, when it will not slow the network down.

Significant signage
So to summarise – remember why we need signage. Good signage ideally incorporates colour coding. It provides information about the services and facilities of the hospital and enables people to easily identify where they are currently and in what direction they need to go. It provides identification of wards, rooms and also areas, which are not accessible to the general public. It also has to meet statutory requirements. For example, there needs to be appropriate safety and warning signs, indicating fire exits and slip and trip hazards. Digital signage is a good flexible format to provide up to date messages. Finally, it is important to carry out regular checks to ensure that your signage is working and if any signs need replacing. Good management of signage will improve the experience of a hospital visit for patients and visitors and make it a more pleasant environment for staff.

Further information
www.iosh.co.uk