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February 27, 2017

How to build a better hospital, according to one doc

Daily Briefing

"As a doctor, I'm struck daily by how much better hospitals could be designed," Dhruv Khullar, a resident at Massachusetts General Hospital and Harvard Medical School, writes for the New York Times' "Well."

Khullar writes that despite the relative cost and complexity of building a hospital, "evidence suggests we've been building them all wrong—and that the deficiencies aren't simply unaesthetic or inconvenient. All those design flaws may be killing us."

Design flaws

Khullar argues that poor hospital design can contribute to hospital-acquired infections (HAIs). For instance, he cites a study found that installing "easier-to-clean surfaces, well-positioned sinks, and high-quality air filters can further reduce infection rates."

And other research highlights the health benefits of private patient rooms when it comes to curbing infection rates, Khullar continues. For example, one study found that private rooms can cut the risk of airborne infection and infections transmitted via contaminated surfaces, while a second study showed that moving patients from shared to private rooms cut bacterial infections in half and curbed patients' length-of-stay by 10 percent. Moreover, research also "suggests that the increased cost of single-occupancy rooms is more than offset by the money saved because of fewer infections," Khullar writes.

Shared patient areas can undermine patient care in other ways, Khullar continues, citing a study that showed that patients are more likely to keep parts of their medical history secret or refuse parts of a physical exam while in a curtained room.

Hospital design can also contribute to patient falls, Khullar writes, pointing to design factors like poor lighting, slippery floors, and toilet height, as well as the amount of time it takes staff to reach patients. Referencing a study on hospital design, Khullar explains that decentralized nursing stations that provide staff with direct lines of sight to patient rooms "can reduce the risk of falls and injuries."

Noise is another factor to consider, Khullar writes. He points out that the average hospital noise level "far exceeds guideline-based recommendations," and that can interfere with patients' ability to sleep.

Hospitals can reduce noise exposure through use of earplugs, sound-absorbing acoustic panels, quieter staff conversations, and curbing unnecessary alarms, Khullar suggests, citing research showing that such strategies can improve patients' sleep quality.  

How the right design can help patients

In addition to research showing the benefits of single rooms and comparatively quiet hospitals, Khullar points out that "some of the most interesting research on the way hospitals are built examines the role of nature to promote healing." For instance, he cites a study of patients recovering from gallbladder surgery that found patients who had a view of trees from their room had shorter hospital stays and took fewer pain medications than patients whose view overlooked a brick wall.  

And it doesn't have to be a real view—just a picture can be beneficial, Kullar writes. He cites another study that found that psychiatric patients tend to "require far fewer medications for anxiety and agitation" when walls have photos of landscapes as opposed to being bare or showing abstract art.

"It's clear," Khullar concludes, "that evidence-based medical care will require evidence-based hospital design" (Khullar, "Well," New York Times, 2/22; Minemyer, FierceHealthcare, 2/22).

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