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Evidence-based hospital design provides structure for improved care

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Patient safety

Evidence-based hospital design provides structure for improved care

After reading this article, you will be able to:

  • Discuss the elements of Dublin Methodist Hospital’s design
  • Recall patient care benefits of Dublin Methodist Hospital’s design

Dublin (OH) Methodist Hospital has not had a hospital-acquired infection since it opened January 8, 2008.

Lamont Yoder, RN, MSN, MBA, FACHE, CNO, attributes the hospital’s infection control success not only to its staff members’ compliance, but also to the physical environment in which they work every day.

“Private rooms are not just for the luxury of having a private room,” says Yoder. “They’re actually for the [patient] outcome.”

Private rooms are not the only design element keeping the hospital a safe place to heal. Dublin Methodist was designed with consultation from the Center for Health Design (CHD), a nonprofit research, education, and advocacy organization that conducts research to guide hospitals on best design practices for healthcare organizations.

Hundreds of research reports conducted by the center gathered evidence on the effect of healthcare design on patient care, quality, outcome, and safety. One such report includes Bronson Methodist Hospital in Kalamazoo, MI, which changed its rooms from all semiprivate to a combination of semiprivate and private in 2000. The hospital saw infection rates for the entire facility drop by 11%; infection rates in units that changed from semiprivate to private dropped by 45%.

“The work [CHD has] done over these last 10–20 years have shown quite conclusively that physical environment actually makes a difference to patient safety and quality improvement,” says Anjali Joseph, PhD, director of research at CHD. “What we’ve been suggesting is that physical environment should be a part of the bundle of interventions that are put in place.”

Private rooms, fewer transfers

Not only do patients have their own rooms at Dublin Methodist, but they also move around much less, which Yoder says reduces infection rates. “This is probably one of the most unique aspects in the design,” he says, referring to the hospital’s acuity-adaptable model of care, which allows any patient to stay in the same room until he or she is discharged. “We don’t have geographically delineated locations for certain types of patients. We don’t have a medical floor, then a surgical floor, and then an intensive care unit.”

Instead, rooms are adaptable, and nurses bring medical equipment to the patient. If a patient goes on a ventilator late at night, the ICU nurse will bring the ventilator to the room, and the patient stays put, Yoder says. This also reduces confusion that often occurs when patients’ families come in the next day to find their relative moved, he adds.

This model of care has been implemented in single-specialty hospitals with much success. Clarian Methodist Hospital in Indianapolis used this method and reduced medication errors by 70%, according to a research report by Joseph. Dublin Methodist is the first multispecialty hospital to test this type of care. Private rooms affect patients in other ways too. Sleep patterns improve and patients communicate better with families and caregivers because they are less reluctant to share personal details when there is no neighbor nearby, Yoder says.

Better light, less noise

Light and noise are significant areas of interest for CHD. Natural light in patient rooms can help patients gain better orientation, decrease confusion in some patients, and is associated with a shorter length of stay and lower use of pain medications, says Yoder.

Although Joseph says there hasn’t been much established research on the environmental effects on medical errors, one CHD study found that better lighting in the pharmacy lowers medication dispensing errors. Crowding and noise in the pharmacy could also cause distraction and potentially lead to errors, says Joseph.

“We have an extremely quiet environment,” says Yoder, explaining that this improves communication between staff members and physicians as well as between patients and their caregivers. It also improves patient sleep patterns.

Dublin Methodist doesn’t have centralized nursing stations. Instead, it has working areas called perches, which are smaller, sitting- or standing-height stations closer to patient rooms. From each perch, a nurse can see three to five rooms. The perches also eliminate communication barriers.

“When [patients or families] want to talk to a nurse or physician, [they] don’t stand on the opposite side of a desk or have glass between [them],” Yoder says.

Joseph says decentralization also lessens staff member fatigue. However, the system works properly only if supplies are also decentralized so less walking is required of nurses.

Dublin Methodist, an all-digital, paperless, and wireless hospital, also uses technology to reduce noise. Staff members wear a wireless communication badge that uses voice recognition to call, page, or text. The system replaces overhead pages and alarms. The badge comes with an earpiece and is integrated with call lights and cardiac monitors to alert the appropriate nurse of an immediate need. Nurses can also hear through their earpieces if patients deemed at risk for falls try to get out of bed.

Dublin Methodist has standardized patient rooms, a design Joseph says helps reduce medical errors. “It’s easier for the staff to go in knowing what to expect rather than rethink everything in a stressful situation, which can potentially lead to a mistake,” she says.

Visible sinks, visible patients

Many patient safety officers know that the location and number of hand washing sinks and dispensers affect hand hygiene compliance, but there are other environmental elements that should be considered, Joseph says. “It’s easy to put the blame on the staff members, but it’s not that they don’t want to [wash their hands]. Often, it’s that the environment does not make it easy for them to do it,” she says.

Joseph recommends sinks be in the path of movement and highlighted by visual design. At Dublin Methodist, the sinks are visible to patients, so there is no question whether caregivers have washed their hands. Because of patient room design, caregivers can get to patients from the sink without touching doors or curtains, eliminating potential contact with bacteria after washing.

When it comes to patient falls, studies have shown that the environment is just one of many factors that may have an effect, Joseph says. Decentralized nursing perches help keep patients visible to staff members, reducing falls.


Adapted from Briefings on Patient Safety, January 2009, HCPro, Inc.