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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

SURGICAL SUITE: Neurosurgical operating room of the future incorporates aeronautical industry concepts

The next phase of the OR of the future is to focus at the cellular level through next-generation imaging that will allow advanced interrogation of normal and diseased neural tissue…which will be systematically captured in the background, curated, and analyzed by the informatics system.”

How to redesign the neurosurgical operating room to incorporate concepts borrowed, in part, from the aeronautical industry is explored in this scholarly article.  How to improve patient safety by focusing on data collection and on honing the science of surgery is discussed.  This article is based on pioneering work being done at the Aurora Neuroscience Innovation Institute (Milwaukee) in collaboration with vendors Storz Corp., Stryker Corp., Synaptive Medical, and Nico Corp.

Source: Kassam, A.B., and others. (2017, June). The operating room of the future versus the future of the operating room. Otolaryngology Clinics of North America, 50(3), 655-671.  Click here for the publisher’s website: http://www.sciencedirect.com/science/article/pii/S0030666517300166

Here is a link to the Aurora Neuroscience Innovation Institute website: https://www.aurorahealthcare.org/services/neuroscience  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: Planning tips for hybrid ORs

Here are some of the considerations / recommendations in planning a hybrid operating room, which integrates imaging equipment into the operating room, based on comments of a steering committee responsible for developing an exhibit at an upcoming national conference:

  • Physician champions are needed
  • Turf issues as far as who controls the hybrid OR must be worked out
  • It takes about a year in planning time
  • Multi-disciplinary hybrid OR steering committee should meet every 2 to 3 weeks
  • 1,200 sf should be adequate for the hybrid OR and the control room
  • The hybrid OR should be part of the surgical suite and close to blood bank

Source: Wood, E. (2015, Sept.). Learn from hybrid OR experts at annual conference Town Hall. OR Manager, 31(9), 1, 7-9.  http://www.ormanager.com/learn-hybrid-experts-annual-conference-town-hall/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Facilities planning for the community hospital of the future

HammerNewly-designed community hospitals are slimming down, re-purposing some areas, and relocating functions off campus, according to this interesting article by a senior exec at a facilities planning consulting firm.  As accountable care organizations (ACOs) develop, hospitals will become a point on the continuum of care rather than the focus of the health care delivery system.

There will continue to be a role for flagship hospitals.  Community hospitals of around 150 beds will right-size at about 2000 to 2250 BGSF / bed (building gross square feet), down from 2500 BGSF per bed.  Nursing unit size used to be around 700 DGSF / bed (departmental gross square feet) — now it is moving down to 550 to 650 DGSF/bed in several example projects that the author mentions.  Observation room, at 180 SF, can be used to reduce the number of inpatient beds needed.  The purpose of lobbies is being re-thought to give them multiple uses.  Hospital support functions can be moved offsite and consolidated for those facilities part of larger systems.

Source: Skolnick, C.  Capital ideas: health facility planning in the post-reform era.  Health Facilities Management;26(4):23-28, Apr. 2013.  Click here for full text: http://www.hfmmagazine.com/hfmmagazine/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/04APR2013/0413HFM_FEA_planning  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

INNOVATIONS: Emergency department design

This comprehensive article, based on an extensive literature review, covers all sorts of operational innovations that hospitals are trying in order to improve their emergency departments, and then discusses the implications for facility design.  Data from the Emergency Department Benchmarking Alliance (EBDA) indicate that emergency departments with less than 20,000 annual visits do better on performance metrics than larger EDs, suggesting the consideration that larger EDs be broken into smaller functional units.  These smaller EDs could then be differentiated by acuity or chief complaint.  The concept of the Breathing ED,which means cyclically opening and closing portions of the ED according to patient load, is discussed.  Among the other concepts discussed include:

  • Triage models (should intake be done by physicians or teams instead of triage nurses?)
  • Triage pods
  • Care initiation areas
  • Low flow-high flow process model
  • Routine ordering of EKGs for patients with chest, neck, and abdominal symptoms
  • Pull to full
  • Fast track
  • Med teams
  • Geographic zones
  • Internal waiting rooms instead of housing patients in ED treatment rooms
  • Reclining chair units
  • Express admissions units
  • Discharge kiosks
  • Clinical decision units

Why I like this article:  It covers so many concepts in a thoughtful and well-researched fashion.

Source: Welch, S.J.  Using data to drive emergency department design: a metasynthesis.  HERD. Health Environments Research & Design Journal;5(3):26-45, Spr. 2012.  Click here for the publisher’s website: http://www.herdjournal.com/ME2/Default.asp  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

PATIENT ROOM DESIGN: Ergonomic considerations

An argument for standardizing the design of the hospital patient room is that caregivers spend less time in searching for necessary items, which is particularly important in emergency situations.  This study took a look at whether it is possible to come up with an optimal patient room design as far as approach to the bed and placement of the IV pole.  Nurses of different ages and experience levels were given three tasks to perform with an actor portraying a patient in 9 different patient room configurations.  Almost all (87 percent) of the actions that were identified as being potentially harmful or stressful had to do with the caregiver’s interaction with the bed or the headwall.  Only 13 percent were related to the room configuration.  These potentially harmful or stressful actions mostly involved bending and stretching. 

Source: Pati, D., and others.  The biomechanics of patient room standardization.  HERD. Health Environments Research & Design Journal;5(2):29-45, Wint. 2012.  Click here for the publisher’s website: https://www.herdjournal.com/ME2/dirmod.asp?sid=&nm=ArtIcles%2FNews&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=3&Tier1=Research  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Private rooms help reduce hospital acquired infections

The Canadian Standards Association has issued standards aligned with US recommendations in that new hospital construction should have single patient rooms.  In Canada, over half of hospital beds are in wards of four or more per room, and hospitals charge more for semiprivate or private rooms than for wards, a price differential that totals an estimated $200 million or more in Ontario alone.  An interesting observation, coming from Roger Ulrich, an international hospital design expert:

  • “…the operational costs of running a hospital for 30 years are at least 15 times higher than the initial capital costs.”

The arguments in favor of single patient rooms are summarized in this series of brief articles.  Among these are patient safety, patient preference (an estimated 90 percent of patients think that having other patients in the room is a significant source of stress), and the ability to run the hospital at a higher occupancy rate. 

Sources:  Stall, N.  Private rooms: a choice between infection and profit.  CMAJ. Canadian Medical Association Journal;184(1):24-25, Jan. 10, 2012.  Click here for full text: http://www.cmaj.ca/content/184/1/24.full.pdf ; Stall, N.  Private rooms: the fiscal advantage.  CMAJ. Canadian Medical Association Journal;184(1):E47-E48, Jan. 10, 2012.  Click here for full text: http://www.cmaj.ca/content/184/1/E47.full.pdf ; Stall, N.  Private rooms: evidence-based design in hospitals.  CMAJ. Canadian Medical Association Journal;184(2):162-163, Feb. 7, 2012. Click here for full text: http://www.cmaj.ca/content/184/2/162.full.pdf  Canadian Standards Association.  CSA Z8000: Canadian Health Care Facilities: Planning, Design and Construction, 2011.   A copy can be purchased here: http://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000/  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org