WBB's Thought Leadership

Evidence Suggests Changes in Hospital Design May Improve Patient Outcomes

February 28

Research shows that having fewer shared patient rooms, decentralizing nursing stations, reducing noise, and providing nature views lead to shorter patient stays.

Excerpt: “Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient.”

“It’s no secret that hospital-acquired infections are an enormous contributor to illness and death, affecting up to 30 percent of intensive care unit patients. But housing patients together very likely exacerbates the problem. … One studyreported that transitioning from shared to private rooms decreased bacterial infections by half and reduced how long patients were hospitalized by 10 percent. Other work suggests that the increased cost of single-occupancy rooms is more than offset by the money saved because of fewer infections.”

“Falls in the hospital are another major problem, leading to serious injuries, longer hospital stays and significant costs. … A number of design factors contribute: poorly lit areas, slippery floors, toilets that are too high or too low. How quickly staff members can reach patients also makes a difference. For example, decentralized nursing stations that are closer to patient rooms and allow nurses direct lines of sight to beds can reduce the risk of falls and injuries.

There’s also much we can do to improve the patient experience, which, of course, is inextricably linked to how well patients rest and recover. …”

“The average noise level in hospitals far exceeds guideline-based recommendations, making it hard for patients to sleep. Reducing exposure to noise — through earplugs, sound-absorbing acoustic panels, quieter staff conversations, and fewer unnecessary alarms — can improve the quality of patients' sleep..

“Some of the most interesting research on the way hospitals are built examines the role of nature to promote healing. Research pioneered by Roger Ulrich, now a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden, suggests that when it comes to recovering from illness, the more nature the better. But too often patients and physicians find themselves cooped up in dim rooms and sterile hallways with little access to natural light or views of nature: too much concrete, not enough jungle.”

“Research supports an urgent need to change the way we build, maintain and work in hospitals, and many facilities could do more to promote rest and healing while preventing stress and infection. It’s clear that evidence-based medical care will require evidence-based hospital design.”

Source:The New York Times

WBB Take: The built environment plays a foundational part in quality and safety, and quality improvement perspectives should be part of the design and activation of healthcare facilities. Physical layout influences patient flow, while choice of materials, lighting, and construction methods will influence a wide array of elements that are important to quality and safety – including visibility and glare, slip resistance, microbial resistance, ease of cleaning, and ease of maintenance. Even with the best design, some risks and issues are only uncovered during simulated workflow walkthrough tests prior to build-out. In many cases WBB has observed that simulation walkthroughs were incomplete and suboptimal. In some cases not all stakeholders were included. In one case, nurses were not part of the walkthroughs. As a result, some transitions and handoffs were made less efficient, and nurses experienced frustration and rework. In other cases, WBB observed that some workflows were not simulated. In one instance, the handoff of a primary care patient to mental health was not tested in simulation, and in practice resulted in several phone calls, physically walking the patient to a different wing, and having the patient wait at several different locations before a warm handoff could be completed. Such outcomes could have been prevented by more comprehensive simulation tests prior to build-out and activation of the facility.

Cited by Rachel Condy

Cited by Rachel Condy



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