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PATIENT FALLS: Canadian study evaluates rubber flooring in long-term care setting

Falls are a major health concern for older adults world-wide, particularly in long-term care (LTC), where approximately 60% of residents fall at least once per year, and 30% of falls cause injury…”

The value of installing a synthetic rubber flooring (compliant flooring) over a concrete floor was compared to plywood over concrete in this randomized trial conducted at one long term care facility in British Columbia.  There were 74 private rooms in the intervention group and 76 in the control group in this 4-year study.  The researchers concluded that the rubber flooring was “not effective for preventing serious fall-related injuries in LTC.”  This article includes interesting tables showing details about the nearly 2,000 patient falls recorded over a 4-year period in this one Canadian facility.  The vast majority of falls occurred in the patient room (excluding the bathroom).  Falls were most likely to occur in the evening and least likely to occur in the afternoon.  There were 85 falls resulting in serious injury,

Source: Mackey, D.C., and others. (2019, June 24). The Flooring for Injury Prevention (FLIP) study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial. PLoS Medicine, 16(6).  Click here for free full text:  https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002843&type=printable  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ISOLATION ROOMS: How many air changes per hour?

Design considerations for negative isolation and positive isolation rooms are discussed in this brief article by an engineering consultant.  Negative-pressure isolation rooms are intended to keep an infectious patient from infecting others in the hospital.  Positive isolation rooms are the opposite – intended to keep germs away from an immunocompromised patient in the room.  The recommendation for both types of isolation rooms is reported to be at least 12 air changes per hour.  Some hospitals use isolation rooms for general patients when they are available.  Although allowed in the past, it is no longer possible to operate isolation rooms that can be switched back and forth from negative to positive pressure.

Source: Herrick, M. (2017, February). Pressure points: Planning and maintaining air isolation rooms. Health Facilities Management, 30(2), 29-32.  Click here: http://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SPACE PLANNING: How to determine number of ORs needed

Tips for the planning process for a new surgical suite are given in this brief newsletter article by an experienced health care architect.  There are some interesting facts that are otherwise difficult to find in the literature:

  • What is the difference between an operating room and a procedure room?
  • What is a hybrid operating room?
  • How are some of the metrics used defined – room time, room turnaround time, throughput?
  • What is a target room turnaround time? (“…usually 15 to 20 minutes”)
  • How many hours are procedure rooms open? (“Most procedure rooms are available eight hours per day for a total of 480 minutes per day”)

Scheduling efficiency: A scheduling efficiency factor is multiplied by the annual minutes available per procedure room to account for periods of time that a case cannot be scheduled.  This factor may range from 70 percent for ORs or procedure rooms used for complex (and sometimes unscheduled) procedures — such as cardiothoracic, neurosurgery, and trauma/orthopedics — to 90 percent for an outpatient suite where all procedures are scheduled.”  (page 3)

Source:  Hayward, C. (2017, Winter). How many operating rooms? It’s complicated. Click here for newsletter: https://www.spacemed.com/newsletter/news101.html  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

DESIGN: Innovative bed placement in patient rooms

Florida Hospital Waterman (Tavares, FL) experimented with a new patient room furniture arrangement when moving a 30-bed unit into some shelled space.  The idea was that patient satisfaction would increase if the headwalls of patient beds were NOT visible from the corridor.  This configuration was thought to increase privacy and decrease noise.  The architects studied the results on an existing unit and then on the new unit and found mixed results.  The patients did find the new unit quieter but caregivers were neutral about recommending the new design.


Ferenc, J. (2016, July 20). Study tests one way to change patient room design and satisfaction. Health Facilities Management.  Click here:  http://www.hfmmagazine.com/articles/2342-study-tests-one-way-to-change-patient-room-design-and-satisfaction

GS&P wins Certificate of Research Excellence for study on patient room orientation. (2015, Oct. 16). Press release.  Click here: http://www.greshamsmith.com/news/awards/gs-amp-p-wins-core-award-for-study-on-patient-room   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

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

OPERATING ROOMS: Relative humidity below 30 percent raises concerns

In 2010, the American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) changed its standard for relative humidity in the operating room.  The previous recommendation was for a range of 30 to 60 percent; the revision drops the lower range to 20 percent.  This position paper issued jointly by the American Hospital Association, the Health Industry Distributors Association, and the Association of periOperative Registered Nurses, among others, raises concerns about this change because of the sensitivity of certain electro-medical equipment to dry air conditions.  A series of questions that a hospital or ambulatory surgery center might use to analyze the issues related to dropping to 20 percent humidity are included.

Source: Relative humidity levels in the operating room: Joint communication to healthcare delivery organizations. (2015, Jan.). Retrieved from http://aorn.org/-/media/aorn/guidelines/position-statements/posstat-endorsed-relative-humidity-joint-communicaiton.pdf

SPACE PLANNING: Imaging GSF per procedure room

Health facility space planners sometimes make use of benchmark ratios such as those given in this very short article to determine a preliminary space estimate based on the number of procedure rooms desired.  Here is an example: For CT scanners, 1,200 to 1,500 departmental gross square feet per procedure room.  The lower end of the range is for larger suites; the higher end for smaller suites.  Similar ratios are given for radiography/fluoroscopy, mammography, MRI, ultrasound, and nuclear medicine.  There is also a ratio given for outpatient multi-modality diagnostic imaging centers.

This information comes from Hayward & Associates, a health care facility planning consultancy that publishes the design manual SpaceMed.

Source: Estimating diagnostic imaging space based on the number of procedure rooms. (2015, Fall).  SpaceMed Newsletter. https://www.spacemed.com/newsletter/rule-83-imagingspace.pdf