Building a Better Hospital Just What Doctor Ordered for Patients, Staff

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Hospitals are unnecessarily risky and stressful places, but a number of improvements to the design of hospital facilities could reduce stress and risk for patients and staff, reveals research by Texas A&M University professor of architecture Roger Ulrich.

The findings by Ulrich and colleague Craig Zimring of Georgia Tech are part of the most extensive review ever conducted of the "evidence-based approach" to hospital design -- an analysis of more than 600 research studies showing how specific elements of hospital design and architecture can promote patient healing and recovery by reducing medical errors, hospital-acquired infections and stress.

As many as 98,000 Americans die each year because of preventable medical errors while in the hospital, and one in 20 of all those admitted contract dangerous infections every year during hospital stays, according to a report by the Robert Wood Johnson Foundation, a co-sponsor, along with the Center for Health Design, of the six-month study.

The study found that poor hospital design contributed to anxiety, increased blood pressure, pain, sleeplessness, patient injuries from falls, poor communication from staff to patients and heightened staff fatigue and turnover. It also provided recommendations for improved design.

"Patients can be safer, they can receive better quality care and they can clearly be much more satisfied with that care," noted Ulrich at a recent National Press Club briefing in Washington.

The report also reveals that building a better hospital is a smart business decision. Leonard Berry, a marketing professor at Texas A&M who studies healthcare services, contributed to the report, finding that building such a facility would cost about $12 million more to build than a conventional hospital, but the improved design features would pay for themselves within a year. In addition, similar cost savings could be expected each year for the life of the facility, Berry notes.

"This is not about luxury; it's about building a safer, more efficient hospital," Berry said.

Based on their research, Ulrich and Zimring recommended hospitals employ some specific design features such as getting rid of double-occupancy rooms and providing patients with single rooms that can be adjusted to meet their medical needs as they change during their stays. Although the up-front cost of private rooms is higher, the report says, significant savings will accrue from lower rates of infection, readmission and transfers as well as shorter hospital stays. Such a change would also increase patient privacy and result in improved communication between patients and staff, Ulrich notes.

Other suggestions include improving air quality with well-designed ventilation systems and air filters to reduce airborne nosocomial infections, hospital-acquired infections that, in one year alone, cost $4.5 billion and contributed to more than 88,000 deaths. Noting that a large proportion of these infections are also acquired by contact with environmental surfaces and unwashed staff hands, Ulrich says strategically placed sinks and dispensers for hand disinfectants can also have a significant role in reducing nosocomial infections.

"This design approach may be more effective than staff education in heightening hand-washing compliance and thereby reducing infections," he says.

Ulrich notes that hospitals should also use sound-absorbing tiles and carpeting to reduce noise, which will lower stress for staff and patients; provide better lighting and access to natural light to reduce stress and improve patient safety; be easier to navigate for patients and their families; and create comfortable environments for staff, patients and their families.

One hospital that utilized the evidence-based design approach in its $181 million redevelopment demonstrated an 11 percent reduction in nosocomial infections, nursing turnover rates below 7 percent (the national average is 20 percent), 95.7 percent overall patient satisfaction, improves staff satisfaction and an increase in market share, Ulrich notes.

"The key elements of evidence-based design clearly can substantially reduce the incidents of hospital-acquired infection, can reduce the incident of medical errors -- medication errors in particular -- and can very substantially reduce stress among patients, their families and hospital staff," he said.

Source: Texas A&M University

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