Calling For Backup In The Patient Room
The patient room as we know it today has been greatly influenced by the field of evidence-based design (EBD), stemming back to 1984, when Roger S. Ulrich’s seminal study “View through a Window May Influence Recovery from Surgery” was first published in the journal Science.
Ulrich led the industry to the light—literally. His research captured the benefits that a simple view outdoors might have on post-surgery patients, including a reduction in pain and length of stay. By the ‘90s, the nonprofit Center for Health Design was launched, promoting a connection between the built environment and health outcomes. In 2000, the term “evidence-based design” was coined and healthcare projects across the country were steeped in the concept of basing design solutions on proven data.
And in 2014, you won’t find a new patient room built that doesn’t provide natural daylight to its occupants. Evidence gathered over the years has shaped this space in a number of other ways, too, including the use of artwork as a positive distraction and placement of hand-washing sinks at the room entry to encourage staff and visitors alike to help infection control initiatives.
The latest and most substantial physical incarnation of theoretical study is the family zone. “There’s enough evidence out there right now that supports having family space in the room and having them spend the night—hands down, that’s definite,” says Cyndi McCullough, evidence-based design director for HDR (Omaha, Neb.).
By accommodating family members comfortably—including provisions for overnight stays (pull-out sofa bed or recliner), independent lighting/entertainment controls, storage, workspace/wireless access, and so on—patient satisfaction ratings often benefit as well as outcomes, thanks to the family being more involved in the caregiving process.
However, there are plenty of patient room design concepts that remain untested (or, at least, unproven), or challenges that designers wish were researched to identify appropriate environmental solutions. And rising to the top of the heap right now is the issue of noise.
“That’s the biggest complaint we get from patients,” McCullough says. “And it’s affecting reimbursement.”
Under healthcare reform, reimbursement rates are now tied to HCAHPS scores for satisfaction, so a patient stay rife with beeps and chatter and void of rest and relaxation will affect more than patient outcomes.
“Noise needs to be researched right now,” agrees Ana Pinto Alexander, principal, senior vice president, and director of healthcare interior architecture at HKS (Indianapolis). “We’re going on a little knowledge and common sense, which is good, but we don’t have enough data on noise control and what we can do to reduce noise in the patient room.”
What designers do know is that those beeps and chatter can be addressed fairly easily thanks to technology (for example, switching to mobile paging and equipment alarm systems) and decentralizing nurses’ stations. However, the question of how to design the unit, specifically, to diminish the din of an operational work environment right outside patient room walls remains an area crying out for research.
Additionally, designers say they’d like to see more evidence related to the mounting adoption of same-handed patient rooms, or those oriented exactly the same in each instance, as opposed to mirrored rooms that place the patient beds on a shared headwall. Same-handed rooms are alleged to be quieter for patients thanks to that single headwall but are also theorized to cost more to build. Some argue the rooms haven’t been proven to really benefit patients, while others say the standardization involved in building them offsets the added cost of that individual headwall.
Meanwhile, Carolyn BaRoss, principal and firmwide healthcare interior design director for Perkins+Will (New York), says evidence that supports amenities in the patient environment would be useful, as well.
“Perhaps types and quality of lighting could be studied. … I’d love to know more about the impact of access to outdoor space on a person’s recovery—whether immediate access to fresh air through a roof garden or terrace, for example, provides any measurable benefit to the patient,” she says.
And even those design interventions that have already proven beneficial could stand to be studied a bit more deeply, says Ryan Hullinger, a principal at NBBJ (Columbus).
For example, what if the presence of family in the room might have more value beyond improved outcomes and reduced length of stay? “Perhaps the next generation of research will be tied to family and there being an opportunity for education, now that you have a captive audience. Being able to promote healthy lifestyle changes to the patient and the family while they’re in that space and setting up the patient room to make it easier for that educational mission to happen could be a key in fixing chronic disease and inspiring lifestyle change,” he says.
As the patient room continues to evolve in response to new trends in how care is delivered, knowing what will best support patients, staff, and families—and having evidence that proves it so—will be an important piece to advancing this critical space.
To read more from Healthcare Design's patient room special report, see the following:
- Stakes Are High For Patient Room Design: The patient room is home away from home and, increasingly, where all the action happens—providing countless reasons to makes sure the design is right. This in-depth look at the state of patient room design today is the first installment in Healthcare Design’s special report on the patient room.
- Unit Design Is Secret To Successful Patient Room: The effectiveness of any patient room design requires an equally effective unit design that supports efficient, functional, and safe operations and care delivery. Designers weigh in on best practices for inpatient unit design in this installment of Healthcare Design’s special report on the patient room.
- Crystal Ball—Looking Into The Future Of Patient Room Design: See a sneak peek of patient room projects on design boards today and details on how healthcare designers are reimagining this all-important space, the third installment in Healthcare Design's special report on the patient room.
- What's Next For Patient Room Design?: NXT Health’s Patient Room 2020 prototype made waves through the healthcare design industry when launched last year. In this installment of Healthcare Design's special report on the patient room, NXT Health executive director Salley Whitman talks about the model and how the concepts proposed continue to evolve and push patient room design forward.