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FACILITY DESIGN: How healthy is the indoor environment?

…it is estimated that people in developed countries now spend 90 percent of their lives indoors.”

What is known about the effect of microorganisms found indoors on health is reviewed in this technical report published by the National Academies Press.  Among the topics covered are air sources, water sources and building surfaces.  Physical and chemical interventions that may help to reduce problems caused by hazardous microbes are covered.

Source: National Academy of Sciences, Engineering, and Medicine. (2017). Microbiomes of the built environment: A research agenda for indoor microbiology, human health, and buildings. Washington, D.C.: The National Academies Press.  Click here for free full text: https://www.ncbi.nlm.nih.gov/books/NBK458827/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ED DESIGN: 8 to 12 exam rooms in independent freestanding emergency departments

Architect Jon Huddy, an expert in emergency department planning and design, has written a second edition of his landmark handbook on ED design, which has just been released by the American College of Emergency Physicians.  Here are some of his observations about sizing of emergency departments.

  • 8 to 12 exam rooms is the “sweet spot” for independent freestanding emergency departments
  • Freestanding emergency departments that are part of hospitals tend to have more exam rooms than those that are independent
  • 1,300 to 1,500 patients/room/year has been a typical planning metric for main hospital EDs
  • 1,800 patients/room/year has been a planning metric for main hospital EDs with lower acuity patients and shorter length of stay
  • 1,800 to 2,200 patients/room/year for a new freestanding emergency department — that typically starts operation with lower acuity patients and ramps up to those with more complex, time-consuming problems over time
  • 1,700 to 1,900 patients/room/year for established freestanding emergency departments – he advises clients to go with an average of 1,800 as a starting point for planning discusisons
  • 2,200 to 2,400 patients/room/year might work for urgent care centers

Source: Huddy, J. (2016, Apr.). Emergency department design: A practical guide to planning for the future (2nd ed., pp. 264-265). Dallas: American College of Emergency Physicians. Click here: http://bookstore.acep.org/emergency-department-design-a-practical-guide-to-planning-for-the-future-2nd-ed-516615  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Certificate of Need: State Health Laws and Programs

The first certificate of need [CON] program was implemented by New York state in 1964, and other states followed after the 1974 National Health Planning Resources Development Act required that states develop a structure to review major health care capital projects involving new construction or investment in high cost technology. The intent was reduce or restrain costs by coordinating new construction and services based on need. Nearly all states had developed health care planning controls by the late 1970s, but the federal law and the related funding for states was repealed in 1987.

Currently, 36 states still maintain some type of CON program, but the programs vary in scope. The National Conference of State Legislatures has published a useful overview of CON programs, covering their intent and structure, the views of CON supporters and opponents, alternative approaches to CON, which states have or don’t have CON programs, and what facilities or services are regulated by which states. Web links are provided to the CON programs in those states that have them or to health planning agencies in the other states without CON laws.

Sources:

Certificate of need: state health laws and programs. National Conference of State Legislatures, Sept. 2015. http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx

CON background. American Health Planning Association, accessed Jan. 8, 2016 at http://www.ahpanet.org/copnahpa.html

Mitchell M and Coopman C. 40 years of certificate-of-need laws across America. Mercatus Center, George Mason University, Oct. 14, 2014. http://mercatus.org/publication/40-years-certificate-need-laws-across-america

Related resources:

Lee T and others. Health care certificate-of-need laws: policy or politics. National Institute for Health Care Reform Research Brief, no. 4, May 2011. http://www.nihcr.org/index.php?download=119ncfl17

Rosko MD and Mutter RL. The association of hospital cost-inefficiency with certificate-of-need regulation. Medical Care Research and Review 71(3):280-298, June 2014. http://www.ncbi.nlm.nih.gov/pubmed/24452139

Jacobs BL and others. Certificate of need regulations and the diffusion of intensity-modulated radiotherapy. Urology 80(5): 1015-1020, Nov. 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505690/

Lorch SA and others. The impact of certificate of need programs on neonatal intensive care units. Journal of Perinatology 32(1):39-44, Jan. 2012. http://www.ncbi.nlm.nih.gov/pubmed/21527902

Update Jan. 13, 2016: Stratmann T and Baker MC. Are certificate of need laws barriers to entry? How they affect access to MRI, CT, and PET scans. Mercatus Center, George Mason University, Working Paper, Jan. 12, 2016. http://mercatus.org/publication/are-certificate-need-laws-barriers-entry-how-they-affect-access-mri-ct-and-pet-scans

 

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Health Facility Design Knowledge Repository

The Center for Health Design provides a knowledge repository on its web site, listing articles, reports and other resources related to health design. Users can search or browse the resources by publication year, article type, design category, environmental condition, outcome category, and research category. A full citation and abstract of each resource are provided.

The repository is financially supported by the American Institute of Architecture’s Academy of Architecture for Health, the Academy of Architecture for Health Foundation, the American Society for Healthcare Engineering, and the Facilities Guidelines Institute. Abstracting support is also provided by the Nursing Institute for Health Care Design and Research Design Connections.

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Staffing a new hospital? You can recruit about 20 to 40 percent from within the health system

Baptist Health South Florida is a faith-based health system with 6 hospitals.  One of these is the West Kendall Baptist Hospital in Miami, which opened in Spring 2011.  This new hospital is notable for several reasons, including that it is the first brand new hospital that was not a total replacement hospital to be built in the Miami area in over three decades.  This article is a description of the start-up of the new hospital that had the goal of achieving Magnet status within two years.  (An application for Magnet status was submitted early in 2014.)

I was intrigued by this fact related to recruiting staff for the new hospital:

  • “…consultative feedback from other health systems opening a new hospital showed that they were able to recruit only 20% to 40% from within their system.  To preserve the BHSF [Baptist Health South Florida] culture, without hurting affiliate entities, WKBH [West Kendall Baptist Hospital] set a target of 50% and, with thoughtful planning and processes, were able to meet this goal.”

Source: Harris, D., and Cohn, T. (2014, Aug.). Designing and opening a new hospital with a culture and foundation of Magnet: an exemplar in transformational leadership. Nurse Leader, 12(4), 62-68, 77.  Click here for the publisher’s website: http://www.nurseleader.com/article/S1541-4612%2813%2900272-3/pdf   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Future of health care construction

Health Facilities Management and the American Society of Healthcare Engineering have released the results of the 2012 hospital construction survey.  The double whammy of an economy still in recession and the uncertainty of how health care reform will play out have left many projects on the drawing board with no immediate plans for execution this year.  The bulk of construction activity is tied up in expansions and renovations, as opposed to new or replacement facilities.

Data are provided for the following:

  • Projects by service line
  • Projects involving building services equipment
  • Projects involving building services systems
  • Impact of reform on projects by service type
  • Prevalence and budgeting for commissioning
  • Construction budgets
  • Patient room design

The full article, complete with charts, is available online.

Carpenter, Dave, and Hoppszallern, Suzanna.  Time to build: 2012 hospital construction survey.  Health Facilities Management.  25(2):12-18, 20, February 2012.    http://www.hfmmagazine.com/hfmmagazine_app/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/02FEB2012/0212HFM_FEA_CoverStory&domain=HFMMAGAZINE

Re-forming the ambulatory care clinic

If the health care delivery system is a pond, then the Affordable Care Act was a boulder dropped into an already chaotic surface, generating ripples and counter-ripples that will take years, if ever, to diminish.  A recent article in Health Facilities Management, an e-magazine published by the American Society of Healthcare Engineering, discusses the effect that the ACA legislation is having on the design of ambulatory care clinics.

Patient-centered care and transparency are key aspects of the post-reform delivery system and ambulatory care is evolving to reflect those values:

  • Information technology is the stitching that holds the seamless continuum of care together: linking a spectrum of providers together through the electronic health record; bringing specialists to an on-site consultation through telemedicine; enhancing the patient experience by setting it free from the confines of the waiting room with the use of pager devices, etc.  Outpatient centers incorporate technology into every space, up to and including the broom closet!
  • The “open team center” approach has evolved to capitalize on the coordinated team approach to outpatient care.  The health care team works in clustered zones, rather than in offices segregated by profession, to increase communication, coordination of care, and elimination of duplicative processes and paperwork.
  • The universal patient room, which made its first appearance in the acute care setting, has been co-opted by ambulatory care centers that want to maximize utilization of each treatment room.
  • Patient-centeredness manifests itself in many ways: Wii games access in a pediatric waiting room (How cool is that!); separate entrances for patients needing urgent care versus routine care; college campus clinic kiosks that allow for self-scheduling and include interactive programs for patient interviewing; etc. 

The future is here – c’mon in!

 

Source: Sweetland, Deborah.  Elements of care: ambulatory design in a post-reform world.  Health Facilities Management.  January 2012.  http://www.hfmmagazine.com/hfmmagazine_app/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/01JAN2012/0112HFM_FEA_Elements&domain=HFMMAGAZINE 

 

 

New cancer pavilion: designed for healing

In March 2011, Baylor Health Care System (Dallas, TX, www.baylorhealth.com) opened a 467,000 square foot outpatient cancer center as the newest component of the Sammons Cancer Center, more than tripling the space devoted to caring for patients with cancer.  The outpatient pavilion was designed and constructed with the specific objective of reducing carcinogens in both the building materials and internal furnishings to create a truly healing environment.  Among the amenities provided to patients and visitors are an education center, a meditation room, a nondenominational chapel, a gift shop that caters to cancer patients, and both indoor and outdoor eating areas.  A bridge to the original Sammons Cancer Center, which has been converted into an inpatient tower, provides an interior link between the two patient care spaces, along with a substantial area devoted to clinical research, including the Innovative Clinical Trials Center. 

 

Eagle, A.  Beating cancer.  Baylor’s new outpatient center reflects advances in treatment.  Health Facilities Management.  November 2011.  http://www.hfmmagazine.com/hfmmagazine_app/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/11NOV2011/1111HFM_FEA_CoverStory&domain=HFMMAGAZINE

Family-centered ICU: humanizing high-tech medicine

The traditional intensive care patient room embodies the worst attributes of the healing environment: aesthetically sterile; the patient lying isolated in a nest of tubing, wiring, and blinking, beeping equipment; family and friends crowded into a common waiting room, visiting the patient one at a time, but always in danger of getting in the way of nurses and other staff caring for the patient.

 

The Medical Center of Central Georgia, Macon, is looking to change that image with the renovation of an old general 33-bed ward into a cutting edge, 14-bed ICU, complete with alcoves in each room designed specifically for the use of family and friends who may be visiting or staying with the patient.  The unit is also implementing an open-visitation policy, allowing two visitors in the room at a time and providing for overnight stays, using sleeper sofas in the family alcoves.

 

The challenges of repurposing a general ward built in the 1970s into a modern ICU are reviewed in brief and photographs capture the mix of centralized and decentralized administrative and support functions within the patient- and family-friendly space.

 

Source: Herring, Richard.  Family intensive: Medical Center of Georgia ICU enhances experience of family members.  Medical Construction & Design.  7(4):26-30, July/August 2011.  http://mcdmag.epubxpress.com/link/MCD/2011/jul-aug/1?s=0

Patient room design: advantages of same-handed concept

Nursing unit design using a standardized “same-handed” design was found to be superior in some respects to a “mirrored” design, in this research conducted at two hospitals.  The findings suggest that the same-handed design concept resulted in patient perceptions of lower noise levels, better quality sleep, and a greater likelihood that nurses approach the bed on the patient’s right side (which has been associated with a lower rate of near falls).  Nurses reported higher satisfaction with the way the work space is organized on the same-handed units as well. 

What I like about this article:  1. That is an actual research study, not just an opinion piece.  2. The first author is the director of research at HOK, a large architectural firm.  3. Although they did not formally study this concept, they also discuss the advantages of “balanced headwalls.” 

Source: Watkins, N., and others.  Same-handed and mirrored unit configurations: is there a difference in patient and nurse outcomesJONA. Journal of Nursing Administration;41(6):273-279, June 2011.  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org