By David Schicht
In a high-pressure hospital environment, where decisions impact patient lives, the ease at which healthcare providers can move from place to place, access equipment and supplies, and see and hear the patient they are treating has a significant impact on both clinical and financial outcomes. Furthermore, studies have shown how environmental factors, including noise levels, lighting and air quality, impact patient satisfaction and well-being.
In the U.S., an estimated $200 billion in taxpayer money is spent per decade on hospital construction.1 As hospitals are increasingly challenged to deliver higher quality patient care at a lower cost, a growing number are taking a critical look at the design of their workspaces to determine how design improvements can support their clinical and financial goals.
One U.S. hospital used an evidence-based design approach, backed by research, when investing $181 million into the redevelopment of its campus. This included private rooms for all patients, creative use of light and nature, and shorter walking distances for patients and families with seating along the way.1 This led to:
- 96% overall patient satisfaction
- Below 7% nursing turnover rate (national average is 20%)
- 11% reduction in nosocomial infections
- Improved staff satisfaction
- Increased market share
Below are six key areas to consider when designing a new hospital or redesigning an existing acute care space.
1. Noise: Noise produces annoyance for pretty much every patient group, and many studies agree that noise may affect outcomes by increasing sleeplessness and elevating heart rate.2 In a study of 3,425 consecutive patients admitted to a medical-surgical unit, measures to reduce nighttime noise and support Circadian rhythms resulted in 8.6 hour reduction in length of stay, 16 percent reduction in 30-day readmission rates, and improved patient self-rated emotional/mental health rates.3
2. Lighting: A lack of windows /daylight for example in the intensive care unit (ICU) has been associated with higher rates of anxiety, depression and delirium. On the other hand, in a study of myocardial infarction patients, those who had been assigned to sunny critical care rooms demonstrated lower mortality rates.4
Good lighting is also essential to improving employee performance, health and safety. A study published in the Health Environments Research and Design Journal found a significant relationship between nurses’ access to lighting controls (switches and dimmers) and satisfaction about the lighting environment, with the researchers stating: “Thoughtful design of the lighting environment can improve nurses’ satisfaction and perception about their working environment.”5
3. Layout: A poor layout of patient care units and patient rooms limits the amount of time nurses have available for care: According to one motion study of more than 1,000 hours of nursing time on a medical-surgical unit, nurses only spent 1.1 to 3.3 hours in every 12-hour-period caring for patients, the remaining nine to 11 hours were spent walking between the patients’ rooms and the nursing unit core.6 A badly designed patient room can also directly affect patient safety: the majority of falls of hospitalized patients occur in the patient’s room, usually when going to the bathroom.7
On the other hand, when nurses and project architects collaborated on the layout of a new 224-bed Level 1 trauma center, with additional private patient rooms, two decentralized nurses’ stations, additional medication dispensers and supply access points, and an optimized layout that increased visibility and reduced walking distances, nurses’ mean steps taken and energy expenditures were significantly reduced, and there was a 55 percent reduction in patient falls.8
4. Storage: A lack of adequate storage space means that medication carts or wheelchairs are often found in the hallway, blocking travel for both patients and caregivers and introducing safety hazards (falls, fire, public access to medications and supplies).
Upon studying how the design of the corridors of a spinal cord injury unit and a brain injury unit influenced the activities affecting patients and staff experience, researchers suggested the following design improvements: Provide additional storage areas or alcoves to place equipment such as wheelchairs and other equipment out of the travel pathway, and design corridors in rehabilitation facilities to be wider than code minimum – wide enough for two-way traffic – and entry/egress points (doorways and elevators) to accommodate wheelchairs.”9
5. Air Quality: According to some estimates, up to 50 percent of all illnesses are either caused by, or aggravated by, polluted indoor air.10 It is therefore particularly important for hospitals to maintain proper heating, ventilating, and air-conditioning (HVAC) systems and other engineering systems.11
In a 2020 review describing variation in standards and guidelines on HVAC system maintenance in the intensive care units (ICU) across the world, the researchers commented on the importance of air quality in ICU design: “Knowledge and understanding of proper functioning of HVAC systems is crucial for critical care physicians, infection control committee members and the administrators to provide optimal safety and comfort to the ICU patients, staff and visitors, while reducing the spread of airborne infections.”12
6. Soft Touches: Finally, soft touches can have a huge impact, as the following example shows: At a U.S. acute psychiatric clinic, “as needed” injections of antipsychotic drugs were 70 percent lower during the weeks that posters of nature scenes were hung on the walls than when the walls were blank. By reducing the number of as-needed injections, the hospital projected a potential cost savings of over $30,000.13
Hospital workspace design also impacts many other factors, from hygiene/infection risk to staff satisfaction and turnover. For additional information on evidence-based design factors read the white paper: Workplace Design: How it affects clinical and financial outcomes here.
1 Evidence-Based Hospital Design Improves Healthcare Outcomes For Patients, Families and Staff, Robert Wood Johnson Foundation, https://www.rwjf.org/en/library/articles-and-news/2004/06/evidence-based-hospital-design-improves-healthcare-outcomes-for-.html
2 Yinnon, A. M., Ilan, Y., Tadmor, B., Altarescu, G., and C. Hershko (1992). Quality of sleep in the medical department. BJCP, 46 (2): 88-91.
3 Milani RV, Bober RM, Lavie CJ, Wilt JK, Milani AR, White CJ. Reducing Hospital Toxicity: Impact on Patient Outcomes. Am J Med. 2018;131(8):961-966. doi:10.1016/j.amjmed.2018.04.013 https://pubmed.ncbi.nlm.nih.gov/29729240/
4 Milani RV, Bober RM, Lavie CJ, Wilt JK, Milani AR, White CJ. Reducing Hospital Toxicity: Impact on Patient Outcomes. Am J Med. 2018;131(8):961-966. doi:10.1016/j.amjmed.2018.04.013
5 Hadi, K., DuBose, J. R., & Ryherd, E. (2015). Lighting and Nurses at Medical–Surgical Units: Impact of Lighting Conditions on Nurses’ Performance and Satisfaction. Health Environments Research and Design Journal, 9(3), 17-30. https://doi.org/10.1177/1937586715603194
6 US Committee on the Work Environment for Nurses and Patient Safety; National Academies Press (US) 2004.
7 Dykes et al., Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?, J Nurs Adm. 2009 June 39(6) 299-304.
8 Copeland,D.,&Chambers,M. 2016HealthEnvironmentsResearch&Design Journal. Pages 1-15
9 Colley, J., Zeeman, H., Kendall, E., 2017½ Health Environments Research & Design Journal, Volume 11, Issue 2, Pages 1-14
10 10th International Conference Enhanced Building Operations, Kuwait, https://core.ac.uk/download/pdf/79627196.pdf.
11 Leung M et al, Med Sci Monit 2006;12:SR17-23.
12 Saran, S., Gurjar, M., Baronia, A. et al. Heating, ventilation and air conditioning (HVAC) in intensive care unit. Crit Care 24, 194 (2020). https://doi.org/10.1186/s13054-020-02907-5
13 Yamaguchi Y, Harvard Business Review 2015, https://hbr.org/2015/10/better-healing-from-better-hospital-design.
David Schicht is Senior Marketing Manager for Workplace Infrastructure at Dräger
This article was republished with permission from Dräger. It originally appeared as a blog post in INSIGHTS by Dräger. INSIGHTS by Dräger is a continuous series of ideas and innovations that can help you achieve your clinical and business goals by improving clinical outcomes, managing the cost of care, ensuring staff satisfaction, and enhancing the patient experience. Check it out here.