Paper
Wednesday, July 11, 2007
Hospital of the Future:Design and Delivery Models for the 21st Century
Barbara J. Mayer, RN, MS, CNS and Linda Urden, DNSc, RN, CNA, FAAN. Nursing Education, Palomar Pomerado Health, Escondido, CA, USA
| Learning Objective #1: describe the process to establish an evidence-based hospital facility design. |
| Learning Objective #2: discuss expected improvements of an evidence-based hospital design in both patient/clinical and caregiver outcomes. |
Current issues affecting healthcare have lead many to undertake ambitious programs to expand facilities. Key market, operational and regulatory contributing factors include: 1) population growth with a disproportionate increase in the senior age range who have greater healthcare needs; 2) nursing shortage; 3) ageing workforce; 4) high occupancy rates; 5) bottlenecks in patient flow from the emergency department; and 6) replacement of ageing hospital structures and required retrofitting of older hospitals to meet seismic requirements.
The Institute of Medicine published “To Err is Human,” in which it was estimated that 98,000 deaths attributable to medical errors occur annually. This has resulted in public interest about hospital-related morbidity and mortality, and created momentum for the work of the Center for Health Design (CHD), a research collaborative that evaluates the effect of the build environment on outcomes in healthcare. Using a model based on evidence, progressive healthcare organizations partner with CHD in three year “Pebble Projects” to develop scientific evidence about attributes that should be considered in new building plans.
The purpose of this presentation is to describe the process used to establish an evidence-based design for a new hospital. Evidence is focused on the following desired outcomes for patients: decreased medication errors, nosocomial infections, noise, pressure ulcers, inter-unit transfers, treatment delays and falls with injury. Caregiver outcomes include decreased turnover, fatigue, stress, time hunting for and gathering supplies, walking distances, wasted supplies; and increased efficiency, time at the bedside, and better observation of patients. Both patient and caregiver satisfaction is expected to increase. The outcomes will be achieved by three major facility design investments: single-occupancy rooms, decentralized nursing stations, and acuity-adaptable rooms (standardized rooms designed with space, dimensions, and features to accommodate a wide variety of patient conditions, needs, equipment, and staffing during changing stages of illness and recovery).