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Special Issue "Improving Patient and Staff Safety through Evidence-Based Healthcare Design"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 18727

Special Issue Editors

Prof. Anjali Joseph
E-Mail Website
Guest Editor
Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC 29634, USA
Interests: patient safety; evidence-based design; healthcare architecture; operating room design; simulation
Dr. Ellen Taylor
E-Mail Website
Assistant Guest Editor
The Center for Health Design, 1850 Gateway Blvd # 1083, Concord, CA 94520, USA
Interests: patient safety; evidence-based design; healthcare architecture; falls, safety risk assessment

Special Issue Information

Dear Colleagues,

In 2000, the Institute of Medicine (IOM) report “To Err is Human” shocked the world by highlighting the significant number of adverse events resulting in patient harm, injuries, and deaths in the US healthcare system. The IOM report emphasized that these events were often preventable, resulting not from the actions of individuals but as the result of faulty and poorly designed systems. A call to action was issued to improve patient safety through system design.

Twenty years later—where are we? The built environment is a critical component of system design for healthcare delivery, and in the early 2000s, the term evidence-based design (EBD) appeared. EBD is defined as the process of basing decisions about the built environment on credible evidence, with the goal of improving healthcare outcomes. Researchers in EBD focus on the role of facility design in improving patient and staff outcomes, including through safety, and the status of healthcare-associated infections, patient falls, medical errors, staff burnout, injuries, etc. Research on safety in EBD has evolved over 20 years, incorporating theories and methods from other fields including environmental psychology, human factors, and systems engineering. For this Special Issue, we invite theoretical, methodological, and empirical papers focused on improving patient and staff safety through the design of built environments.

Prof. Anjali Joseph
Dr. Ellen Taylor
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • patient safety
  • staff safety
  • healthcare facility design
  • hospitals
  • evidence-based design
  • architecture
  • health systems
  • simulation
  • post-occupancy evaluation
  • teamwork

Published Papers (8 papers)

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Research

Article
Using Virtual Reality (VR) Mock-Ups for Evidence-Based Healthcare Facility Design Decisions
Int. J. Environ. Res. Public Health 2021, 18(21), 11250; https://doi.org/10.3390/ijerph182111250 - 26 Oct 2021
Cited by 2 | Viewed by 1405
Abstract
(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of [...] Read more.
(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of using VR mock-ups to conduct a simulation-based mock-up evaluation. (2) Methods: Data collected from scenario enactments within a VR mock-up was compared to data collected from an existing medication room with the same design to assess predictive validity. Outcomes regarding quality and patient safety were also examined as a result of design modifications to the VR mock-up which were identified through a post-occupancy evaluation (POE) of the existing medication room. Survey data from participants, hospital design stakeholders, and POE recommendation recipients captured perceptions regarding the evaluation process. Specifically, this included perceptions regarding mock-up and scenario realism as well as utility of the evaluation process. (3) Results: Evidence-based data collected using the VR mock-up accurately assessed workflow (link analysis), bumps, impediments, interruptions, and task completion times. Collecting data pertaining to selection errors and equipment placement were identified after procuring the VR software and therefore the accuracy of these measures was not assessed. Searching behaviours were not possible to capture using the VR software. A 506% return on investment was achieved through the VR mock-up evaluations. (4) Conclusion: Organizations should consider what evaluation objectives are planned and how they will be measured for a mock-up evaluation to determine if VR is appropriate. Full article
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Article
Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response
Int. J. Environ. Res. Public Health 2021, 18(18), 9747; https://doi.org/10.3390/ijerph18189747 - 16 Sep 2021
Viewed by 2551
Abstract
This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients’ perception of staff responsiveness. The first part of this study is a retrospective pre–post and cross-sectional study evaluating the impacts of unit design [...] Read more.
This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients’ perception of staff responsiveness. The first part of this study is a retrospective pre–post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients’ perception of staff’s “promptness in responding to call button” and “help with toileting”. This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development. Full article
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Article
Designing a Patient Room as a Fall Protection Strategy: The Perspectives of Healthcare Design Experts
Int. J. Environ. Res. Public Health 2021, 18(16), 8769; https://doi.org/10.3390/ijerph18168769 - 19 Aug 2021
Cited by 2 | Viewed by 1676
Abstract
Despite decades of research into patient falls, there is a dearth of evidence about how the design of patient rooms influences falls. Our multi-year study aims to better understand how patient room design can increase stability during ambulation, serving as a fall protection [...] Read more.
Despite decades of research into patient falls, there is a dearth of evidence about how the design of patient rooms influences falls. Our multi-year study aims to better understand how patient room design can increase stability during ambulation, serving as a fall protection strategy for frail and/or elderly patients. The aim of this portion of the study was to ascertain the architect’s perspective on designing a room to mitigate the risk of falls, as well as to evaluate the face validity of a predictive algorithm to assess risk in room design using the input of a design advisory council (AC). The purpose of this paper is to provide insight into the design process and decision-making for patient rooms; summarize the impressions of industry experts about the configurations and layout of the patient rooms tested in a preliminary augmented reality model; establish the face validity of modeled heat maps depicting risk; and report the results of a pre-meeting and post-meeting survey of expert opinions. Feedback was coded using human factors/ergonomic (HF/E) design principles, and the findings will be used to guide further development of an “optimal” prototype room for human subject testing. The results confirm the challenges that architects face as they balance competing priorities and reveal how a participatory process focusing on preventing falls can shift assumptions about design strategies, especially subtle changes (e.g., toilet orientation). Full article
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Article
Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study
Int. J. Environ. Res. Public Health 2021, 18(16), 8758; https://doi.org/10.3390/ijerph18168758 - 19 Aug 2021
Cited by 3 | Viewed by 2065
Abstract
Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While [...] Read more.
Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations. Full article
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Article
Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety
Int. J. Environ. Res. Public Health 2021, 18(16), 8391; https://doi.org/10.3390/ijerph18168391 - 08 Aug 2021
Cited by 7 | Viewed by 2593
Abstract
The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using [...] Read more.
The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research. Full article
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Article
Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries
Int. J. Environ. Res. Public Health 2021, 18(15), 8114; https://doi.org/10.3390/ijerph18158114 - 31 Jul 2021
Cited by 2 | Viewed by 1987
Abstract
(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and [...] Read more.
(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR. Full article
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Article
Room Size Influences Flow in Robotic-Assisted Surgery
Int. J. Environ. Res. Public Health 2021, 18(15), 7984; https://doi.org/10.3390/ijerph18157984 - 28 Jul 2021
Cited by 3 | Viewed by 1522
Abstract
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact [...] Read more.
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = −2.488, df = 54, β = −0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration. Full article
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Article
DEEP SCOPE: A Framework for Safe Healthcare Design
Int. J. Environ. Res. Public Health 2021, 18(15), 7780; https://doi.org/10.3390/ijerph18157780 - 22 Jul 2021
Cited by 1 | Viewed by 3083
Abstract
Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of [...] Read more.
Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of this paper is to theoretically explore how we think about harm as a systems problem by mitigating the risk of adverse events through proactive healthcare facility design. We review the evolution of thinking in safety as a safety science. Using falls as a case study topic, we use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provide a way to synthesize design interventions into a systems-based model for healthcare facility design using human factors/ergonomics (HF/E) design principles. The DEEP SCOPE matrix is proposed to highlight the design of safe healthcare facilities as an ergonomic problem of design that fits the environment to the user by understanding built environments that support the “human” factor. Full article
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