When a person goes to receive medical care, they typically enter with a level of anxiety. One thing that's usually not on their mind at the time is, "Will I become a victim to a patient fall or trauma? Will a foreign object be left inside my body if I need surgery?" or "Will I get a hospital acquired infection?" The Center of Medicare and Medicaid Services (CMS) calls these scenarios "never events," because they should never occur.

Evidence-Based Design (EBD) for healthcare is defined as the deliberate attempt to base building decisions on the best available evidence, with the goal of achieving the best possible outcomes for patients, family and staff.  Some aspects of EBD have been adopted by the American Institute of Architects guidelines for the design and construction of healthcare facilities.  Most of the design guidelines include infection control risk assessments and mitigation, recommendations on single-patient rooms, promoting patient safety by reducing falls, with the ultimate goal of improving patient outcomes.  There's growing evidence suggesting the physical design of a healthcare environment can unintentionally contribute to negative outcomes.  However, on the other hand, a carefully choreographed EBD facility can help the patient, family and staff come together to enhance the experience, increase safety and deliver a higher quality of care.

Understanding the balance between one-time capital costs and ongoing operational savings is the determining factor for the EBD initiative. An experienced, collaborative design team can analyze the operational cost savings from reducing just one infection, eliminating unnecessary patient transfers, minimizing patient falls or reducing employee turnover to demonstrate the business case for EBD. It should be easy to conclude that there are financial benefits that will continue for many years.  In short, there is a very compelling case for building better and safer hospitals through the integration of evidence based design.  Here a few strategies to consider on your next project:

Increasing Patient Safety

Patient safety outcomes, such as reducing hospital acquired infections and limiting patient falls are directly impacted by the environment of care.  Poor indoor air quality and inadequate hand washing facilities harbor infectious pathogens.  Research shows that single patient rooms are more effective than semi-private rooms or open treatment spaces in reducing the spread of nosocomial infections.  Chaotic environments, poor ergonomics and low light levels compound the burden of stress in your staff, which can result in medical errors.  Research indicates that patients will recover faster in private rooms, medication errors are reduced due to less confusion, and the exchange of confidential medical information is more freely shared.  Additional benefits included reduced noise, enhanced communication and consistently high patient satisfaction scores on the quality of care received.

Improving Clinical Outcomes

Garden of Hope healing garden at James Graham Brown Cancer Center

Loud and distracting noise levels are common in most healthcare settings, and strategies such as single patient rooms and closed room doors are effective in reducing ambient noise levels.  An EBD solution could include positive distractions, such as noise-reducing material selections and the incorporation of music into the space.  Music can be a very beneficial intervention in reducing anxiety and stress, perceived pain associated with medical procedures or the need for conscious sedation.  Providing access to the outdoor environment and healing gardens are also effective in improving a patient's mood and increased feelings of wellness.  Improved outcomes can also be promoted through interior design elements as well through the use of color, finishes, furniture and artwork.

Increasing Social Outcomes

Providing adequate space for families in a patient's room enables the family to spend time with the patient, provides a social interaction and support mechanism during a difficult time.  It also empowers the family to become engaged in the follow up care that will be required, as well as an extension of care for the staff.  Well thought out amenities, like access to computers, can provide a distraction and remove the feeling of being in a hospital are likely to be appreciated.

Healthcare leaders face a new reality; one where you can no longer accept a never event occurring in your facility.  Preventable environment of care conditions such as hospital acquired infections, patient falls, unnecessary patient transfers (which contribute to increased medical errors) all can be significantly reduced though the incorporation of evidence-based design principals.  Administrators need to understand the connection between constructing a well-designed healing environment and the compelling business case for doing it.  To be effective in limiting never events in your facility, incorporate EBD techniques which rely on strategies that produce the best outcomes.

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