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Patient Care Addition Update • December 2008/January 2009

Construction Paves Way for Improved Patient Safety

Construction of the Patient Care Addition (PCA), which will feature 200 private rooms by spring 2010, is part of one of the largest hospital building booms in U.S. history. It’s anticipated that the United States will spend more than $20 billion per year for hospital construction by the end of the decade.

The PCA is easily the most visible component of the hospitals $250 million redevelopment initiative called the Renaissance Project. And the Renaissance Project has provided all involved – experts from many fields – an opportunity to rethink hospital design. It’s a chance to show how improved design can help improve healthcare quality and outcomes in a number of key areas, with one of the most important being matters related to patient safety.

Much of the construction in the new PCA has been guided by what’s called “evidence-based design.” Just as medicine has increasingly moved toward “evidence-based medicine,” where clinical choices are informed by research, evidence-based design is guided by rigorous research linking physical environment of hospitals to patients and staff outcomes.

Why patient safety1

Ten years ago, the Institute of Medicine published a landmark report, “To Err is Human: Building a Safer Health System,” that exposed the tremendous costs, both in human and financial terms, of medical errors in the U.S. health care system.

Two studies cited in the report indicate that between 44,000 and 98,000 people die each year in the United States as a result of medical errors. The national cost to the economy of these errors is between $17 billion and $29 billion.

After the report appeared, research in the cause of medical errors and ways to prevent them increased dramatically. Particular attention was paid to three areas related to patient safety:

Hospital-acquired infections
There have been more than 120 studies linking infection to the built environment of the hospital, but it pretty much boils down to this: Transmission of infection to patients occurs through two general routes – airborne and contact.

Regarding the former, evidence from many studies leaves no doubt that hospital air quality and ventilation play decisive roles in affecting air concentrations of pathogens. In this way, they have major effects on infection rates.

As for the latter, it has been well-established that the hands of healthcare staff are the principle cause of contact transmission from patient to patient, and that the importance of hand washing by healthcare workers cannot be overemphasized for reducing hospital-acquired infections.

Research suggests a clear pattern wherein infection rates are lower when there is very good air quality and patients are in single-bed rather than multi-bed rooms.

Medication errors
Poor lighting, frequent interruptions and distractions, and inadequate private space can complicate filling prescriptions. Well-illuminated, quiet, private spaces allow pharmacists to fill prescriptions without the distractions that lead to medication errors.

Also, there is mounting evidence that the transfer of patients between rooms or different units is a source of medication errors. The reasons why errors plague room transfers include delays, communication discontinuities among staff, loss of information and changes in computer systems.

Reducing transfers, studies suggest, reduces medication errors, saves staff time, shortens patient stays and reduces costs.

Patient falls
This is an area of great importance because patients who fall incur physical injuries and psychological effects and have greater lengths of stay in the hospital. In fact, it is estimated that the total cost of fall injuries for older people will reach $32.4 billion in 2020.

Several studies have suggested that patient falls can be avoided. Poor placement of handrails and small door openings are two primary causes of patient falls. Many falls can also be reduced through providing well-designed patient rooms and bathrooms, and creating decentralized nurses’ stations that allow nurses easier access to at-risk patients.

Tackling these challenges and more

In developing its vision for the Renaissance Project, Northwest Community Hospital developed core principles that now drive the project (see accompanying side bar story). Among those principles are many specifically related to the idea of improving patient safety, and relevant key challenges.

Here are some features that will be part of the new Patient Care Addition, and their direct links to matters of patient safety:

  • Private rooms – will promote lower infection rates due to not passing infections between patients in two-bed rooms. Private rooms also will reduce the need to move patients, and provide more space for families to stay overnight and assist, which will help prevent patient falls.
  • Two sinks per room – one immediately inside the patient room and one in the patient bathroom to allow for better access to hand-washing stations.
  • Charting alcoves with windows into patient rooms – will provide the ability to view the patient from the hall through a window, helping to visualize yet protect patient privacy, keep doors closed for noise reduction, and improve patient sleep by allowing the doors to be closed at night.
  • Standardized (“same-sided”) room layout – so clinical staff won’t have to reorient themselves each time they enter a room.
  • Handrails in patient rooms – continuous hand rails to bathrooms from the head wall of the bed so patients have something to hold on to when walking. Patients do not cross the room to access the toilet.
  • Bariatric accommodations, rooms and toilets – help reduce falls and staff injuries due to appropriately sized equipment.
  • Negative pressure patient rooms – there will be four rooms per unit and also rooms in the Emergency Room, Labor and Delivery, and Special Care Nursery. This will increase the ability to isolate patients with certain types of infectious diseases.
  • Configuration of floors – decentralized pods of rooms to gain efficiencies in staff, reduce staff travel distance and increase direct patient care time.
  • Door openings – large door openings to patient rooms to be able to easily get in and out of the rooms with patients and equipment.
  • Call light system – call goes directly to the nurse’s phone, and if not answered, escalates to another practitioner.
  • Security system – special security systems in high-risk areas to prevent infant or child abduction.
  • Beds – beds will have the feature to go low to the ground in case of patient being a fall risk; alarms to tell if patients are getting out of bed and may need assistance; mattress surfaces that help prevent pressure ulcers; scales in bed so patients can be conveniently weighed.

Renaissance guiding principles

In developing our vision for the Renaissance Project, we asked ourselves questions like: How can we enhance the experiences of our visitors and truly exceed their expectations? How can we take a fresh look at the way physical environments – like patient rooms and family areas – are connected to physical healing? And how can we create soothing spaces that rejuvenate the soul?

The answers to these important questions led to the core principles that now drive the project. These principles, which spell out “Renaissance,” embrace:

  • Respect for the individual needs of all hospital users.
  • Evidence-based design throughout the structure and process.
  • Natural environments that promote health and healing.
  • Adaptability in anticipation of an ever-changing healthcare environment.
  • Integration of holistic care, serving the mind, body and spirit of the hospital’s patients, families and staff.
  • Safety through innovative design features, creating more secure settings that meet all regulatory body requirements.
  • Standardization of processes, supplies and design to create a more efficient environment with increased value.
  • Archetype design elements to provide continuity between the main hospital campus and all sites throughout the community.
  • Needs that are met through patient/family-centered concepts.
  • Community-centered values for the hospital’s services, programs and communications.
  • Enabling of processes through the use of leading-edge technology.

1Information for this article was compiled from three articles: “Mistake-proofing the design of health care processes,” Agency for Healthcare Research and Quality (May 2007); “The role of the physical environment in the hospital of the 21st Century,” Texas A&M University/Georgia Institute of Technology (September 2004); “Transforming hospitals: Designing for safety and quality, AHRQ (date unavailable)

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Last Updated 04/10/2009