Constructing a patient-safe healthcare facility
In the early 1930s, the construction industry considered one death per $1 million spent on construction to be the norm. Worker fatalities, though undesirable, were an accepted corollary to doing business.
Some of the workers who built our nation's most treasured landmarks never lived to see them completed. For example, 11 men lost their lives in building the Golden Gate Bridge, and 10 men were killed during construction of the Hoover Dam. Yet those projects are revered as tremendous successes.
Today such statistics are unacceptable. One fatality, even one accident, can often render a construction project a failure. The construction industry has made great strides in safety education, procedures, and equipment. In the construction industry, the most important project goal is to send every worker home safely at night.
The healthcare industry is facing its own safety crisis and is asking how it can ensure the safest possible environment for every healthcare worker and every patient. The landmark report by the Institute of Medicine, To Err is Human: Building a Safer Health System (which can be found at http://www.search.nap.edu/books/0309068371/html/), states that 44,000 to 98,000 people die per year as the result of medical errors. That makes medical errors the eighth leading cause of death in the United States, taking more lives each year than auto accidents, breast cancer, or AIDS.
Although the healthcare industry has not been diligent in tracking safety statistics, that's starting to change. For example, the Wisconsin Health and Hospital Association recently developed a plan to collect and publish quality and safety information in support of clinical improvement. Terri Potter, president/CEO of Meriter Hospital, has said, “The train has left the station on quality reporting. We can either be engineers or flagmen in the caboose. Once the data [are] gathered we will be in a position to share meaningful information with consumers, purchasers, and employers.”
Now, in conjunction with healthcare, the construction industry is stepping in with its approach to safety consciousness. Contractors, architects, and healthcare administrators realize that they must work together to create patient-safe facilities. But where do we start?
There are, overall, three important issues to consider when constructing a new facility: budget, schedule, and quality. Developing the optimum schedule gives the project greater opportunity for meeting budget and quality standards. If a project is pushed toward a fast-track schedule, as so often occurs, the budget and quality of a building may be compromised. Therefore, the first goal as contractor is to develop a scheduleand that means a set of priorities that will balance the expectations of quality and budget. Within that framework are a number of challenges that will be discussed below that have a direct impact on patient safety.
Commissioning. Even the best-constructed healthcare facility will have problems if the employees are unable to use it properly. Contractors must be committed to making the transition into operations of a new building virtually seamless. Some of the ways to accomplish that include:
Systems. There are two types of systems: procedural and facility. Procedural systems involve staff interaction with the building in performing their work. Facility systems support that process. Some examples of facility systems include fire alarms, bed sensors, and nurse-call units. Although contractors need to work with the healthcare facility to install systems that focus on safety, our job does not end with installation. We must continually research and present new systems possibilities to the owner. For example, building materials that can actually prevent infection are the wave of the future. Imagine doorknobs and phone handsets that kill viruses upon impact. They're not far off.
Safety is a concern not only in new construction, but also in remodels and renovations, which comprise the majority of healthcare construction projects. This type of construction brings its own intricacies because of the proximity of patients and staff and the need to maintain uninterrupted operations. Contractors must address such potential problems as:
Need for negative air pressure. Overall, the use of negative air pressure is a risk- management issueit is part of the contractor's due diligence in addressing infection control and taking seriously the responsibility of monitoring air quality. Contractors must implement designated construction zones where negative air pressure is maintained during construction activities. The negative zone will contain the dust and dirt, keeping potentially harmful agents away from patients.
Noise reduction. The impact of noise on sleep patterns and on the immune system of both staff and patients is well documented. In addition, there is a direct correlation between noise and distraction, creating the opportunity for, and likelihood of, errors and adverse events and, ultimately, a generally unsafe environment. Design features and materials that minimize noise include special sound-absorbing ceiling tile, carpet, isolation of mechanical systems, concrete structures, and careful use of specialized steel. Although specialized steel normally reflects noise, it can be constrained with the installation of additional features and controls, such as housekeeping pads and sound attenuation systems. The mass of concrete structures in itself helps attenuate sounds and minimize vibrations, with no additional controls needed.
Mold. Extensive litigation has recently made all of us aware of the mold issue, which in many ways is the “new asbestos.” A general lack of “official” regulatory standards regarding mold exposure or clean-up, and uncertainty regarding the harmful effects of such exposure, add to the confusion and fear. Construction operations must develop and implement a sequenced schedule that is proactively focusing on preventing moisture problems before they become mold problems.
Life safety. Perhaps one of the biggest safety risks during constructioneither new or renovationis the change in routine it imposes on staff and others. Hospital staff and patients become accustomed to walking the same paths, taking the same staircases, etc. During construction, communication to hospital staff of egress modifications is critical, with posted exit plans, directional signage, and lighting. A simple, but often overlooked, step in this area can have a dramatic impact on safety.
Construction worker training. The Health Insurance Portability and Accountability Act (HIPAA) safeguards the confidentiality of all patient information. During healthcare remodeling projects, construction workers are often in close proximity to people having sensitive, private discussions. Workers should be trained extensively to deal with this type of situation. Contractors should develop a comprehensive training program, including detailed information about patient confidentiality and other healthcare-specific issues. Every tradesperson, including subcontractors, should complete such training before working on a healthcare project.