Enhancing the traditional hospital design process: a focus on patient safety

BACKGROUND

In 2002 St. Joseph's Community Hospital (West Bend, WI), a member of SynergyHealth, brought together leaders in health care and systems engineering to develop a set of safety-driven facility design principles that would guide the hospital design process. DESIGNING FOR SAFETY: Hospital leadership recognized that a cross-departmental team approach would be needed and formed the 11-member Facility Design Advisory Council, which, with departmental teams and the aid of architects, was responsible for overseeing the design process and for ensuring that the safety considerations were met. The design process was a team approach, with input from national experts, patients and families, hospital staff and physicians, architects, contractors, and the community.

OUTCOME

The new facility, designed using safety-driven design principles, reflects many innovative design elements, including truly standardized patient rooms, new technology to minimize falls, and patient care alcoves for every patient room. The new hospital has been designed with maximum adaptability and flexibility in mind, to accommodate changes and provide for future growth. The architects labeled the innovative design. The Synergy Model, to describe the process of shaping the entire building and its spaces to work efficiently as a whole for the care and safety of patients.

CONCLUSION

Construction began on the new facility in August 2003 and is expected to be completed in 2005.

Evidence-based design can improve health outcomes, study says

Despite the availability of hundreds of evidence-based studies, many hospitals--caught up in a wave of new construction and development--are running afoul of the cardinal rule of medicine: First, do no harm, says a new industry report.

Planning a developmentally appropriate neonatal intensive care unit

Neonatal intensive care units (NICUs) are now being redesigned in the wake of growing evidence that the physical environment of the NICU has a profound impact on all who live and work there. These new units reflect the universal trend of bringing families directly into the center of the medical care team. More than ever,such projects are bound to change how staff care for babies, how families interact with babies, how staff and families interact with one another, and how staff interact among themselves. When a NICU decides that a more developmentally appropriate environment should be initiated, the question of funding and obtaining other resources inevitably arises. This chapter identifies the essential components that should be included when planning to seek investments in NICU facilities.

Designing the neonatal intensive care unit for optimal family involvement

The design of a new neonatal intensive care unit provides an opportunity to ensure that the new facility best meets the needs of the infants and families whom the unit serves. In design planning,administrators, staff, family members, and the architect must work together in a self-education process that entails examining current design standards, exploring exemplary facilities at other institutions,defining the priorities and needs of infants, families, and staff, and deciding how to respond to them. The involvement of family members in this important work can help ensure that the facility is responsive to families and supports the family as the primary caregiver and decision maker for the infant. Such an environment will lead to improved health and developmental outcomes for infants and greater family and staff satisfaction.

Meeting essential lighting criteria

Hospital lighting has to meet a variety of special requirements. Lighting performance, ease of maintenance and efficiency are all important, as is patient comfort--and, with the introduction of PFI schemes, there is new focus. Richard Holt, managing director of Trilux Lighting, provides an insight.

Planning the acoustic environment of a neonatal intensive care unit

This article addresses general principles of designing a quiet neonatal intensive care unit (NICU) and describes basic aspects of room acoustics as these apply to the NICU. Recommended acoustical criteria for walls, background noise, vibration, and reverberation are included as appendices. Crowding in open, multiple-bed NICUs is the major factor in designs that inevitably produce noisy nurseries with limited space for parents. Quiet infant spaces with appropriate sound sources rely on isolation of the infant from facility and operational noise sources (eg, adult work spaces, supply delivery, and travel paths) and extended contact with family members.However, crowding has been an important influence on the clinical practice and social context of neonatology. It allows clinicians to rely on wide visual and auditory access to many patients for monitoring their well-being. It also allows immediate social contact with other adults, both staff and families. Giving up this wide access and relying on other forms of communication in order to provide for increased quiet and privacy for staff, infants, and parents is a challenge for some design teams. Studies of the effects of various nursery designs on infants, parents, clinicians, and the delivery of services are proposed as a means of advancing the field of design.

Mothers' arms--the past and future locus of neonatal care?

With the advent of neonatal intensive care, medical professionals inserted themselves between the baby and its family. Even for healthy newborn, the mother could only get to her infant with permission from the medical staff and then only for limited periods and in a very restricted manner. Family-centered care restored the family's right to full access to their baby, but as generally practiced(and certainly as NICUs are currently designed) medical professionals still view the infant as a solitary individual who sleeps most of the time in a bed. Future NICU design should recognize that the baby must spend most of its time in its mother's arms to get the full benefit of her sensory environment as experienced throughout our evolution. NICUs must therefore be planned to facilitate this extended proximity as much as possible (ie, not just providing for parents at the bedside with the bed as the locus of care, but transforming the preferred and predominant locus of care from the bed to the parents' arms, with the design changes inherent to that concept). Designing our units to facilitate this interaction will not assure that it will always occur, but it will guarantee that we have not created permanent structural features that interfere with this crucial relationship.

Lighting design in the neonatal intensive care unit: practical applications of scientific principles

Meeting the varied lighting needs of infants, caregivers, and families has become more complex as our understanding of visual development and perception and the effect of light on circadian rhythms advances. Optimal lighting strategies are discussed for new unit construction, as well as modifications to consider for existing units. In either case, the key concept is that lighting should be provided for the individual needs of each person, rather than the full-room lighting schemes previously used. Ideas gleaned from nonhospital settings, re-introduction of natural light into the neonatal intensive care unit, and new devices such as light-emitting diodes will dramatically change the lighting and visual environment of future neonatal intensive care units.

Guidelines for pediatric cancer centers

Since the American Academy of Pediatrics published guidelines for pediatric cancer centers in 1986 and 1997, significant changes in the delivery of health care have prompted a review of the role of tertiary medical centers in the care of pediatric patients. The potential effect of these changes on the treatment and survival rates of children with cancer led to this revision. The intent of this statement is to delineate personnel and facilities that are essential to provide state-of-the-art care for children and adolescents with cancer. This statement emphasizes the importance of board-certified pediatric hematologists/oncologists, pediatric subspecialty consultants, and appropriately qualified pediatric medical subspecialists and pediatric surgical specialists overseeing the care of all pediatric and adolescent cancer patients and the need for facilities available only at a tertiary center as essential for the initial management and much of the follow-up for pediatric and adolescent cancer patients.

Evidence-based design for infants and staff in the neonatal intensive care unit

Conscientious architects are becoming increasingly aware of the impact of design decisions on the sensory environment of the neonatal intensive care unit (NICU). This article addresses the relevance of theories of environmental psychology to NICU design. Design research on infants and staff in NICUs is summarized, and future research directions are identified.

Capital & candor. To meet the needs of obese patients, hospitals change processes, equipment and attitudes

To meet the needs of obese patients, hospitals are investing in new equipment and renovations, reconsidering processes to avert injuries to staff, and retraining staff to treat those patients with sensitivity. Innovative hospitals are even developing new service lines.

Neutron dose rate evaluation for medical linear accelerators

During X-ray therapeutic irradiation with energies above the threshold of (X,n) reactions in the structural materials of medical accelerators, a photoneutron fluence is generated. In Brazil, no measurements of neutron doses in radiotherapy rooms are being done yet, when licensing these equipment. Consequently, it is very important to obtain accurate analytical formulae and/or simulation of these dose rates, in order to estimate the increase in dose received by the patient and staff, as well as to correctly project the additional shielding for the treatment room. In this work, we present MCNP simulation of dosimetric quantities at the isocentre of some models of high-energy linear accelerators, and compare it with the values given by the manufacturers, finding good agreement between both.

The business case for better buildings

The buildings in which customers receive services are inherently part of the service experience. Given the high stress of illness, healthcare facility designs are especially likely to have a meaningful impact on customers. In the past, a handful of visionary "healing environments" such as the Lucille Packard Children's Hospital at Stanford University in Palo Alto, California; Griffin Hospital in Derby, Connecticut; Woodwinds Health Campus in St. Paul, Minnesota; and San Diego Children's Hospital were built by values-driven chief executive officers and boards and aided by philanthropy when costs per square foot exceeded typical construction costs. Designers theorized that such facilities might have a positive impact on patients' health outcomes and satisfaction. But limited evidence existed to show that such exemplary health facilities were superior to conventional designs in actually improving patient outcomes and experiences and the organization's bottom line. More evidence was needed to assess the impact of innovative health facility designs. Beginning in 2ooo, a research collaborative of progressive healthcare organizations voluntarily came together with The Center for Health Design to evaluate their new buildings. Various "Pebble Projects" are now engaged in three-year programs of evaluation, using comparative research instruments and outcome measures. Pebble Projects include hospital replacements, critical care units, cancer units, nursing stations, and ambulatory care centers. The Pebble experiences are synthesized here in a composite 3oo-bed "Fable Hospital" to present evidence in support of the business case for better buildings as a key component of better, safer, and less wasteful healthcare. The evidence indicates that the one-time incremental costs of designing and building optimal facilities can be quickly repaid through operational savings and increased revenue and result in substantial, measurable, and sustainable financial benefits.

[Patient experiences in Norwegian hospitals--changes over time?]

BACKGROUND

Patient experience has been identified as a national indicator of hospital quality. We describe the changes in patient experiences 1996-2000 for seven Norwegian hospitals.

MATERIAL AND METHODS

A patient experience questionnaire was sent to medical and surgical patients in a stratified random sample of hospitals in 1996. The same questionnaire was used in similar surveys in 1998 and 2000. Responses from hospital wards included in all three surveys were compared on ten summated rating scales. Changes were identified by multiple linear regression.

RESULTS

Responses from a total of 10 600 patients were analysed. For six scales no change was noted: general satisfaction, information on medication, information on examinations, nursing services, doctor services, and organization. Statistically significant improvement was found for three indices: communication, contact with next-of-kin, and information regarding future complaints. For one scale, scores changed for the worse: hospital and equipment. All changes were small.

INTERPRETATION

Patient experiences with Norwegian hospitals did not change much between 1996 and 2000. On some indices, our data indicate slight improvement. Patient assessment of buildings and equipment changed negatively.

Adapting the neonatal intensive care environment to decrease noise

A protocol of environmental noise reduction was developed and tested over a 14-month period in a 70-bed tertiary care neonatal intensive care unit (NICU). Evidence-based research and a detailed sound assessment guided the development of the protocol. Modifications of caregiving activities and categorized changes in the physical environment were specific to the NICU tested; however, guidelines for adapting the protocol to other NICUs are explained as well as methods for implementation to promote staff awareness and cooperation are reviewed.

Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)

The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.

Going green more easily

The drive for compliance with "green" policies in the NHS has seen many property managers considering issues of environmental risk management for the first time in their careers. However, this need not involve a mountain of additional administration if the correct procedures are adopted, says Kate Bashford, senior environmental management consultant at the National Britannia Group.

Risky business. Organizations tackle infection control during construction

Construction projects, no matter how minor, can be dangerous for patients who are especially sensitive to infection. Guidelines from three prominent organizations are finally helping hospitals understand how to prevent infections during those projects.

Planning for patient privacy and hospitability: a must do in oncology care

The number one design challenge in the healthcare environment is the patient room. This space is one of the primary functional areas impacting hospital design and, quite often, the place of greatest controversy. This controversy is due to the length of time the patient spends in the room (compared to other areas), the amount of overall space required and the time dedicated to patient room utilization, maintenance, general arrangement and overall efficiency. In addition, there is a growing list of room types to be considered, many are of the ambulatory care, short stay and observation category. Other room types beyond the routine medical/surgical room include Intensive Care, Coronary Care, Surgical Intensive Care, Skilled Nursing, Rehabilitation and Oncology Care as well as more intensive Bone Marrow Transplantation, for example. Major features of the traditional acute care patient room require the space to be flexible, convertible, expandable and, most importantly, hospitable. For many, many years the patient room was considered a shared space with multiple beds and multiple users. The term semi-private has been used to describe the traditional two-bed and, sometimes 4-bed patient room. This article will address the programmatic elements of an inpatient area, the room and its functional components along with some examples for comparative purposes. For the oncology patient, the development of a family-focused, private room is mandatory. The private room is more flexible, less expensive to operate, safer and environmentally more appealing for the patient, family and staff.

Meeting the challanges in today's outpatient oncology setting: a case study

Physicians and staff in outpatient oncology settings are feeling besieged as healthcare trends accelerate. One of these is to provide a greater number and variety of treatments on an outpatient basis. The second is the shift from indemnity insurance to a managed care environment to help control the costs. The challenge at the Center for Cancer Care at OSF Saint Anthony Medical Center in Rockford, Illinois, was to create processes that increased efficiency, dealt with expanded patient caseloads, improved the level of care provided and took into account the shortage of oncology nurses.