In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Laura Poltronieri is the founding principal at Poltronieri Tang & Associates (Swarthmore, Pa.) and was named the HCD 10 Architect for her work in 2013. Here, she shares her thoughts on the impact of climate change in creating adaptive facilities, designing for mental illness, and using the built environment to fight against antibiotic resistance.

1. ICU delirium

Recent research from physicians at Vanderbilt University has documented significant cognitive problems persisting in patients a year after discharge from intensive care units (ICU). Their research reports that reducing sedative exposure as well as keeping patients alert and mobile during their stay can reduce “ICU delirium” and its ongoing after-effects. These findings, discussed in “Long-Term Cognitive Impairment after Critical Illness,” in the New England Journal of Medicine, could alter how architects design ICU environments, a space historically serving a heavily sedated population that’s frequently unaware of its surroundings and very rarely encouraged to ambulate out of bed. Designers have the opportunity to respond with a new paradigm of ICU design to help reduce the incidence of persistent problems and shift how we view the intensive care space.

2. Chemo at home

I recently attended the National Healthcare Conference in Dublin where Eilish Hardiman, CEO of the Children’s Hospital Group, discussed Ireland's successful and innovative approach to providing chemotherapy and other outpatient parenteral therapies to pediatric patients in their homes. This truly patient-focused approach is a win/win/win for addressing issues of cost, quality, and patient satisfaction. Hopefully, attempts in the U.S. to move toward more accountable approaches for providing high-cost care will look to this successful model from across the pond.

3. Health impacts of global warming

A recent Op-Ed piece by Frederica Perera and Patrick Kinney asserts that the negative health effects of global climate change and fossil fuel consumption are disproportionately affecting children and infants. The piece notes that from 2020 to 2030 ozone-related emergency room visits in New York City are expected to rise by approximately 20 percent. In addition, they argue that “extreme weather events” also disproportionately impact children. As we design EDs, we need to become more aware of these trends as well as the impact that increasing extreme weather events will have on the need to “toughen” our hospitals and plan for surge capacities. The greater challenge, however, arises out of our need to prepare for the new and unprecedented effects climate change may impose on our lives. Although it’s widely agreed that we’ll experience more erratic environmental disasters, a more nuanced understanding of climate change will lend designers greater insight into how to create adaptive healthcare facilities that will best serve future generations.

4. Designing for mental illness

A report from the U.S. Department of Justice, “Mental Health Problems of Prison and Jail Inmates,” states that 56 percent of the prison population is mentally ill. Weekly headlines of tragic events remind us that mental health services and beds in our country are woefully inadequate. Design professionals need to be ready with the knowledge necessary to plan and design systems, communities, and facilities to help this enormously underfunded group. We need to seek inspiration from those European countries that have mental health systems that more appropriately and more humanely meet the needs of their mentally ill populations across the continuum of inpatient and outpatient care.

5. Infection prevention

The World Health Organization’s “Antimicrobial resistance: global report on surveillance,” clarifies that antibiotic resistance is no longer a dire prediction but a problem occurring now around the globe. Researchers are tackling it from all angles. Healthcare designers also play a significant role in helping to control outbreaks and minimize the spread of infection within hospitals. From site selection to detailed design of materials and joints, architects can help reduce the spread of infection and become proactive leaders in design for infection prevention and control.

Laura Poltronieri

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