Based on a scientific review of 320 evidence-based design studies in the academic literature that apply to the field of pediatrics, the report concludes that the physical environment of health care settings affects the clinical, physiological, psychosocial, and safety outcomes among child patients and families.
According to the report, minimizing or eliminating the harmful effects of such environmental factors as loud noise, high light levels, and infectious pathogens should be the goal of children's hospitals and other types of hospitals providing pediatric services. In particular, the neonatal intensive care unit has been the focus of many interventions proven effective in improving infant health outcomes.
The report prioritizes top design recommendations and breaks them out by those that can be implemented at any time at low cost and those that can be implemented during renovation or new construction at moderate to high cost. Examples of proven low cost design recommendations implementable at any time are:
- Hand washing dispensers at each bedside and in all high patient volume areas
- Incubator noise reduction measures (earmuffs, sound absorbing panels) in the NICU
- Circadian (cycled) lighting in the NICU
- Artwork and virtual reality images to provide positive distractions
Examples of proven moderate to high cost design interventions implementable during renovation or new construction include:
- Single-family patient rooms
- Adequate space for families to stay overnight in patient rooms
- Accessible indoor or outdoor gardens
- Visual access and accessibility to patients (e.g. through decentralized nurses' stations)
- HEPA filtration for immune compromised patients
"The exciting news is that well designed hospitals based on evidence can actually increase patient safety and quality, reduce anxiety and stress for child patients and their families and also improve working conditions for hospital staff," said Lawrence McAndrews, president and CEO of NACHRI. "Bottom line is this report challenges children's hospitals and adult hospitals that serve children to evaluate their built spaces and implement design interventions that can help their pediatric patients heal."
"As the industry advances, evidence mounts that thoughtful facility design can help bring patients, staff and families into the center of the health care experience, increase patient satisfaction in the health care environment, encourage family participation, support an already overburdened staff, and advance the overall quality of care provided," added Debra Levin, president and CEO of The Center for Health Design.
Billions of dollars are being invested in new hospital construction and renovation and children's hospitals in particular are incorporating evidence-based design into planning. Evidence-based design is defined as the deliberate attempt to base building decisions on the best available evidence with the goal of achieving the best possible outcomes for patients, families, and staff while improving utilization of resources.
"Hospital leaders and boards face a new reality," said Blair Sadler, a report author and former CEO of Rady Children's Hospital, San Diego. "They must deploy all reasonable quality improvement techniques available to prevent hospital-acquired conditions such as infections and falls, injuries to staff, errors due to unnecessary intra-hospital patient transfers, and stress and anxiety due to noisy and confusing environments."
According to Sadler, these techniques position hospitals well for several major forces beginning to change reimbursement formulas and that require public reporting of quality and safety outcomes and patient satisfaction scores. "When including multi-year operating impacts," added Sadler, "evidence-based design is an excellent long term investment."
