In the 1999 Institute of Medicine’s report, “To Err is Human: Building a Safer Health System,” two studies cited revealed that between 44,000 and 98,000 people die annually in U.S. hospitals due to medical errors, incurring a cost of $17 billion to $29 billion to the national economy. Since the publication of the report, there have been numerous successful initiatives to help hospitals implement cultural and procedural changes to help reduce medical errors. According to AHRQ, there is a link between a hospital’s physical design and its quality and safety outcomes
Evidence-based design is a term used to describe the relationship between the physical environment of a healthcare facility and effects on the patients’ and staff’s safety.
The following are ways in which evidence-based design helps improve safety and quality in hospitals, according to the AHRQ.
1. Prevent patient falls. According to the AHRQ, the annual cost of fall injuries among the elderly will exceed $30 billion by 2020. Additionally, Medicare and Medicaid services no longer reimburse hospitals for the cost of patient falls that occur in their facilities, with private insurers likely to follow suit.
In order to reduce the risk of patient falls, hospital can make design changes, such as improved placement of handrails, bigger door openings and more accessible nurses work stations.
2. Prevent HAIs. Placing patients in single-bed rooms with adequate air filtration systems can reduce rates of hospital-acquired infections, according to the report. Additionally, providing multiple, accessible locations for healthcare providers to wash their hands can also help reduce HAIs.
3. Prevent medication errors. The AHRQ report suggests that implementing environmental design changes such as improved lighting, adequate private space and the removal of distractions can all help prevent errors that occur when filling prescriptions.
Designing acuity-adaptable patient rooms can also help reduce errors because they eliminate the need to transfer patients to different areas of the hospital, which can lead to the miscommunication of patient information between caregivers in different locations, according to the AHRQ.
4. Improve patient satisfaction. The AHRQ report reveals that patient satisfaction is highly influenced by the environment of the hospital.
Reducing excess noise, providing patients and their families with privacy, and making it easier for patients to navigate through the hospital can all contribute to increased patient satisfaction.
5. Improve quality outcomes. According to the AHRQ’s review, numerous elements of hospital design can influence patient outcomes. Hospitals can promote better quality outcomes for patients by reducing noise, which in addition to improving patient satisfaction, can help improve sleep and recovery time and reduce depression. Other methods for reducing patient stress and improving quality outcomes are increasing sunlight in patient rooms, and providing access to nature, art and music.
6. Increasing satisfaction among staff. The AHRQ reports that the average turnover rate for nurses is 20 percent and that stress is the primary factor.
Hospitals can reduce the physical burden on staff and increase productivity in delivering patient care by using acuity-adaptable rooms, which reduce the need for nurses to transfer patients around a hospital, according to AHRQ.
Another design change hospitals can make to reduce the physical burden on nurses is to decentralize nurses’ stations and supply areas to reduce the amount of walking required.
7. Return on interest. While the construction required to implement many of these evidence-based design changes leads to additional costs, this investment will ultimately decrease medical and financial complications that commonly occur in poorly designed facilities. In an analysis by the Center for Health Design of a “fable hospital,” common evidence-based design features added $12 million to the cost of hospital construction, but these costs were projected to be recovered in one year through operational savings and increased revenue.
