“As a doctor, I’m struck daily by how much better hospitals could be designed,” says Dr Dhruv Khullar.

“Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.”

As a resident physician at Massachusetts General Hospital and Harvard Medical School, Khullar says that while it is hard for doctors to rest in the hospital, it can be infinitely harder for patients to stay.

This is mainly due to the design flaws in the hospital design, which can make hospitals hotbeds for illness, injury and poor mental health.

More economical, high-quality and well-designed infrastructures

It is common that hospital-acquired infections are an enormous contributor to illness and death, affecting up to 30% of intensive care unit patients. However, housing patients together very likely accelerate the problem.

A research carried out by Teltsch and colleagues suggests that private rooms can reduce the risk of both airborne infections and those transmitted by touching contaminated surfaces. Another study led by Sadatsafavi and colleagues found that the cost savings from the reduction of infections in single-bed rooms outweighs additional construction and operation expenses.

Besides, installing easier-to-clean surfaces, well-positioned sinks and high-quality air filters can further reduce infection rates, as Khullar elaborated. Cleaning technique is a determining factor to bacteria infections, too.

A number of design factors such as poorly lit areas, slippery floors and toilets that are too high or too low often lead to another major problem - falls, causing serious injuries, longer hospital stays and significant costs. During such events, how quickly staff members can attend to patients also makes a difference. For example, decentralised nursing stations that are closer to patient rooms and allow nurses direct lines of sight to beds can reduce the risk of falls and injuries.

Better hospital environment to improve patient experience

Providing a good environment in the hospital is said to be relevant to how well patients rest and recover. Nonetheless, privacy remains a challenge in hospitals. Research has found that almost all physicians breach confidentiality by discussing patients’ sexual or drug history in rooms while a stranger on the other side of a curtain can hear every word. Hence, patients in curtained spaces might withhold their medical history or refuse parts of the physical exam.

Furthermore, the average noise level in hospitals far exceeds guideline-based recommendations, making it hard for patients to sleep. Reducing exposure to noise through earplugs, sound-absorbing acoustic panels, quieter staff conversations and fewer unnecessary alarms can improve the quality of patients’ sleep, according to Khullar.

A research pioneered by Dr Roger Ulrich, now a professor of architecture at Chalmers University of Technology in Sweden, suggests that the view from a window may influence recovery from surgery. The study found that patients looking out at trees had shorter hospital stays and took fewer pain medications than those viewing a brick wall.

Khullar said, “Many facilities could do more to promote rest and healing while preventing stress and infection. It is clear that evidence-based medical care will require evidence-based hospital design.”

Make adult hospitals more like children’s hospitals

Meanwhile, a recent study suggests a possible remedy for the anxiety associated with hospitalisation: Make adult hospitals more like children’s hospitals.

At children’s hospitals, treatments are generally done in a cluster rather than one at a time. Additionally, young patients are awoken less frequently to allow for more rest, while the atmosphere in rooms and wards is more colourful, to lend a lighter and more jovial atmosphere through the use of cheerful wallpaper and decorations.

Perhaps just as crucial is the greater emphasis on younger patients to engage with artistic activities including writing, painting and music, which can aid in a smoother recovery.

One of the study’s authors, Kumar Dharmarajan, an assistant professor at Yale School of Medicine explained, “Children also go to a specific room to draw blood or undergo other procedures. The idea is children will not associate the stress of a procedure with the room where they are sleeping.

“But on the adult side, patients are routinely awakened in the middle of the night for blood draws, sometimes by an orderly they do not recognise. This is particularly challenging for older adults with memory problems.”

Thus, Dharmarajan stressed that the incorporation of these small tweaks could be a win-win for both hospitals and insurance companies, as it would reduce readmission rates and avoid expensive nursing-home stays. MIMS

Read more:
Design thinking: an out-of-the-box approach to healthcare solutions
Therapeutic landscapes: The role of nature in healing and recovery
How to make medical waiting rooms more welcoming

Sources:
https://www.nytimes.com/2017/02/22/well/live/bad-hospital-design-is-making-us-sicker.html?_r=1
http://www.menshealth.com/health/hospitals-make-us-sicker
https://www.wsj.com/articles/why-hospitals-should-treat-adults-like-children-1487864240
http://www.medicine.mcgill.ca/epidemiology/hanley/reprints/TeltschICU.pdf
https://www.ncbi.nlm.nih.gov/pubmed/6143402
https://www.ncbi.nlm.nih.gov/pubmed/26586445