Transcript Document

Conference ‘Ett schysst sjukrum’
Design to promote health:
Research and evidence-based
practice from children’s hospitals
Roger S. Ulrich, Ph.D.
Texas A&M University
Evidence Based Design
Evidence-based design (EBD) is the
deliberate attempt to base building
decisions on the best available
evidence with the goal of achieving
the best possible outcomes for
patients, families and staff while
improving utilization of resources
Evidence-Based Design Research
Rigorous research to date (approx 1,500
studies) links the physical environment
to outcomes in following major areas:
Improving
 Patient safety
 Other patient outcomes
 Staff outcomes (such as work
satisfaction, retention, effectiveness)
 Overall healthcare quality
 Financial performance
Traditional vs well-designed floors:
Effects on nurse activity
 Travel:
 Traditional: 10-18 km per day
 Well-designed: 2-5 km
 Care time received by each patient:
 Traditional: 16-24 minutes per shift
 Well-designed: 35-45 minutes
 Time spent ‘hunting and gathering’
 Traditional: 40%
 Well-designed: 10%
Providing single
rooms is vital
for adapting to
sicker patients
in future
Combination of:
•
single rooms
•
localized nurse
stations with good
patient observation
•
good ventilation
Cromer Children’s
Univ. of Chicago
Hospital Acquired Infections
• Increase hospital costs per patient
by $40,000 in U.S.
 Increase ICU stays by 8 days/patient,
other stays by 14 days (Clark)
More that 180 studies were identified pertaining
to infection and the hospital built environment
(Ulrich & Zimring, 2004, 2007)
Surfaces commonly contaminated by MRSA
(Methicillin-resistant staphylococcus aureus)
R.S. Ulrich with P.A. Wilson
Problem: Unwashed Staff Hands
Low hand washing compliance
has strong causal link with
contact transmission of infection

Compliance in busy units: 14-28%

Education inadequate and transient
Design to Increase
Hand Washing
Conveniently
located basin in
single room
Soap
dispenser
Automatic
faucet (no
touch)
Easy-to-clean basin
counter (continuous
impervious surface)
Handwash basins and
hand rub dispensers
should be close to
staff movement paths,
visually prominent,
near care point
Alcohol-based
gel dispenser
Patient
Bed
M. D. Anderson
Ambulatory Cancer Center
Houston
Problem: Noise
Hospital noise levels far higher
than recommended values

Noise sources are too
numerous and too loud

Surfaces are sound reflecting
More than 165 studies
(Ulrich & Zimring, 2007)
 Hospital
noise levels are
steadily getting worse
 Noise
levels everywhere
are rising 5 dB per decade
 Much
research shows
noise worsens patient and
staff outcomes
STUDY
[Blomkvist, Eriksen, Theorell, Ulrich and Rasmanis,
2005. Occupational and Environmental Medicine]
• Staff: nurses (36) who were specialists
in cardiology and worked regularly in
the coronary critical care unit
• Findings: During good acoustics staff

experienced lessened work demands

increased workplace social support

improved quality of patient care

better speech intelligibility
STUDY
[Hagerman, Rasmanis, Blomkvist, Ulrich, Eriksen, and
Theorell, 2005. International Journal of Cardiology]
•
Patients: adults (94) diagnosed with
acute myocardial infarction in a coronary
critical care unit in a Stockholm hospital
•
Intervention: Acoustics were improved
by periodically changing ceiling tiles from
sound-reflecting to sound-absorbing tiles
•
Findings: During good acoustics patients
slept better, had less physiological stress,
and a lower incidence of re-hospitalization
Effective design measures for
creating quiet healthcare buildings

Single-bed patient rooms

Install high-performance soundabsorbing ceilings

Reduce noise sources (provide
noiseless paging system, etc.)
Do roommates provide stressreducing social support?
•
Studies on adult patients show
that 85%-90% of the time
roommates are source of stress
not positive social support
 Stress examples: roommate who is
unfriendly or seriously ill
 Roommates generate much noise
Single-bed vs. Multi-bed Rooms
(Ulrich, 2004)
Single Multi-bed
Healthcare associated infections
Medical errors
Falls
Staff observation of patients
Staff/patient communication
Confidentiality of information
Presence of family
Patient privacy and dignity
Avoid mixed-sex accommodation
Death with dignity
Noise
Sleep quality
Single-bed vs. Multi-bed Rooms
(Ulrich, 2004)
Single Multi-bed
Pain
Patient stress
Patient satisfaction
Choice
Staff satisfaction
Staff work effectiveness
Reducing room transfers
Adapt to handle high acuity
Patient privacy and dignity
Managing bed availability
Initial construction costs
Operations and whole life costs
Recommendation of NACHRI:
(U.S. National Association of Children’s
Hospitals and Related Institutions)
“Based on a converging body of
evidence, it is recommended that
single rooms be provided for all
patients in pediatric settings.”
NACHRI (2008). Transforming Children’s Health
Through the Physical Environment, 8.
Design to Reduce Stress
 Design to ensure exposure
to nature, calming gardens,
and natural light that reduce
stress and help lower pain
What we know about
effects of viewing nature
About 40 scientific studies
•
Quickly lowers psychological
and physiological stress
•
Produces clinically important
pain alleviation in adults
•
Other: reduces aggression,
improves satisfaction
Effects of nature window view on
recovery from surgery (Ulrich, 1984)
RESEARCH EXAMPLE
• Shorter stays
• Less pain
• Fewer minor
complications
• Better
emotional
well-being
RESEARCH EXAMPLE
“Distraction Therapy with Nature Sights
and Sounds Reduces Pain During Flexible
Bronchoscopy” (Diette et al., 2003)
• Patients: adult patients (80)
undergoing flexible bronchoscopy
with conscious sedation
• Intervention: Nature scene on
ceiling with tape of nature
sounds. Control group had no
nature scene or sounds
•
Results: Patients with nature distraction
reported significantly less pain
Karmanos Cancer
Outpatient Center
Southfield, Michigan
View from
chemotherapy
patient chair
What types of art are preferred
by adult patients?
•
Vast majority of adult patients across
diverse countries prefers nature art
•
Public likes art that evokes positive
feelings

77% agree “art should be relaxing to look at”

Most “want art that makes me happy”
Provide Access to Daylight
•
Natural light/sunlight has biochemical and physiological effects
that foster improved outcomes in
many types of patients
 Reduction of depression
(improved emotional well-being)
 Mitigation of pain
RESEARCH EXAMPLE
STUDY: Natural light and depression
by Benedetti et al., 2001
Patients:
602 diagnosed with
severe depression
Findings:
Those with high
levels of morning
sunlight (east
facing rooms) had
shorter stays by
3.7 days
WEST
EAST
Morning:
1400 lux
Morning:
15500 lux
Afternoon:
3000 lux
Afternoon:
2700 lux
Children’s Garden
Legacy Hospital
Portland, Oregon
Children’s Garden
Legacy Health
Portland