A comparative evaluation of Swedish intensive care patient rooms

Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis

OBJECTIVES

Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.

ELIGIBILITY CRITERIA

Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.

CONCLUSIONS

The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.

PROSPERO REGISTRATION NUMBER

CRD42022311689.

The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge

OBJECTIVE

The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature.

BACKGROUND

Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service.

METHOD

This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare.

RESULTS

The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports.

CONCLUSIONS

The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.

Operating room nurses' experiences of limited access to daylight in the workplace - a qualitative interview study

Background

The operating room nurse is, among other things, responsible for patient safety and maintaining an aseptic environment. For hygienic reasons unnecessary traffic in the operating room should be avoided, which may mean that the operating room nurse works long shifts without relief. Operating departments are usually separated, where there might be no daylight opportunities in the operating room. The purpose of the study was to describe operating room nurses’ experiences of limited access to daylight in the workplace.

Method

Qualitative design with four semi-structured focus groups of totally 15 operating room nurses. The analysis was performed with a content analysis with an inductive approach.

Results

The study generated two main categories, difference in light and contact with the outer world. Operating room nurses felt that daylight affected them differently from the light from lamps, where daylight was considered important for experiencing well-being. Daylight could lead to a sensation of joy but also increased awareness and energy which seemed to improve the ability to perform at work. The limited access to daylight contributed to fatigue and led to an internal stress that affected the nurses even after work. Having opportunities to look out through windows under a workday was important to experience contact with the outside world and created a sense of time.

Conclusion

To look out can reduce the feeling of being trapped in the closed context that the operating department entails. It can also lead to increased well-being and comfort in the workplace. We consider that daylight is an important component in the physical work environment that needs to be taken into consideration in further research as well as in new construction of operations departments.

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020)

BACKGROUND

The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.

Mapping the impact of ICU design on patients, families and the ICU team: A scoping review

PURPOSE

Scoping review to map outcomes and describe effects of intensive care unit (ICU) design features on patients, family, and healthcare professionals (HCPs).

MATERIALS AND METHODS

Iteratively developed search strategy executed across seven databases. We included studies (January 2007 to May 2020) exploring ICU design features using any study design. We grouped studies into 12 design features and categorized outcomes into four domains.

RESULTS

Of 18,577 citations screened, 44 studies met inclusion criteria. Newly built or renovated ICUs/ICU rooms were evaluated in 27 (61%) studies; 17 (39%) evaluated existing designs/features. Most commonly evaluated design features were lighting (24, 55%), single vs multi-occupancy rooms/pods (17, 39%), and family-centered design (13, 30%). We identified 63 distinct outcomes in four domains; HCP-related (20, 45%); patient-related (20, 45%); family-related (11, 25%); and environment-related (7, 16%). Eleven (25%) studies measured patient/family-reported outcomes. In studies evaluating single occupancy rooms, three reported increased family satisfaction, two reported decreased delirium burden, while six reported negative consequences on HCP wellbeing and working.

CONCLUSION

Studies evaluating ICU design measure disparate outcomes. Few studies included patient/ family-reported outcomes; fewer measured objective environment characteristics. Single room layouts may benefit patients and family but contribute to adverse HCP-related outcomes.

Visitor's Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit

Objectives:

The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms.

Background:

The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting.

Methods:

A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room.

Results:

For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (p < .030); the dimension regarding the ward climate general was also perceived as higher in the intervention room (p < .004). The factors of pleasantness (p < .019), and complexity (p < 0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor (p < .061).

Conclusion:

Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations.

Nurses' Participation in the Design of an Intensive Care Unit: The Use of Virtual Mock-Ups

BACKGROUND

Co-design with multiple tools is useful when end users' knowledge is important, especially when designers work with people unfamiliar with design. Many studies have highlighted the importance of nurses' participation in design, and such participation requires the development of techniques and tools to facilitate collaboration. This article analyzes how nurses participated in designing a general intensive care unit in a walk-in virtual environment (VE) and examines how their work-related knowledge can be transferred to the design process of spaces.

METHOD

In this action research study, the design process was conducted by using virtual mock-ups, which were evaluated by multi-occupational groups in a walk-in VE. Nurses were the largest occupational group. Their work processes were under modification, since existing multi-patient rooms were being redesigned as single-patient rooms. The design of single-patient rooms was performed in three iterative cycles in the walk-in VE.

RESULTS

The nurses could specify their requirements in the walk-in VE, and their suggestions were incorporated into the architectural design process. The nurses were satisfied with their role in the design process.

CONCLUSION

Co-design with virtual mock-ups in walk-in VE is appropriate when designing new healthcare facilities and when the opinions of workers are important. Virtual mock-ups in walk-in VE can be used collaboratively, facilitating simultaneous feedback from multiple users. Virtual reality (VR) technology has evolved, and changes can be made rapidly and at a lower cost. Another advantage of VR is that it allows one to design larger spaces, thus providing larger layouts of facilities for evaluation.

The Correlation Between Visibility and Medical Staff Collaborative Communication in Emergency Departments

OBJECTIVES

This study empirically investigates the correlation between visibility and nurses and physicians' collaborative communication in emergency departments (EDs). The researchers hypothesized that higher visibility levels in EDs are associated with higher collaborative communication among nurses and physicians.

BACKGROUND

The review of related literature addresses the role of communication in EDs, and more specifically, how visibility has been found to affect nurse and physician behavior in healthcare facilities.

METHOD

The visibility levels in four EDs within the same hospital system were quantitatively measured in this study. Also, the communication levels among medical staff were explored by two methods. Data collection included computerized floor plan analyses, observations, and surveys.

RESULTS

The researchers found statistically significant relationships between several underlying dimensions of ED visibility and collaborative communication among the medical staff members.

CONCLUSION

Understanding the role of visibility provides a critical design principle for future EDs. The enhancement of ED design helps nurses and physicians to benefit from supportive environments.

Comparative analysis of environmental noise levels in two paediatric intensive care units

AIMS

1) To determine noise levels in two paediatric intensive care units (PICU) of a tertiary hospital and 2) to analyse whether these values comply with the current standards.

METHOD

Observational, descriptive and cross-sectional study carried out in two PICU with different infrastructure: bays separated by curtains and individual bedrooms. A PCE-999 sound level meter was used to determine noise levels, which were registered in decibels (dB). At the same time, an ad hoc data recording document was designed in which we differentiated between each unit (open concept or closed), time of recording.

RESULTS

A total of 330 tests, 72 from open PICUs and 258 from closed PICUs were collected. The noise in the open PICU was 56.74 ± 3.61 decibels versus 50.36 ± 4.71 in the closed PICU, obtaining the highest levels during the morning.

DISCUSSION

As it occurs in other studies, noise levels exceed the allowed limits. At the same time, the main sources of noise in the PICU came from alarms, medical equipment, such as monitors or respirators, and conversations between health professional.

CONCLUSIONS

This investigation has shown high levels of environmental noise in the two PICUs analysed. The data obtained indicate that the architectural concept of individual bedrooms may have an impact in decreasing this environmental input.

The Influence of Visibility on Medical Teamwork in Emergency Departments: A Mixed-Methods Study

AIM

This mixed-methods study delivers empirical evidence on the influence of visibility on healthcare teamwork in Emergency Departments (EDs). This study researchers hypothesized that with changes of visibility in EDs, teamwork among medical staff members will be impacted.

BACKGROUND

Prior research results suggest that visibility can influence health-setting efficacy. Teamwork is one of the components of each healthcare system that can be supported by environmental design.

METHOD

Visibility in four subject sites from the same healthcare system was objectively measured by morphology plan analyses. Teamwork among medical staff members was the behavioral variable of interest and explored through field observations, interviews, and surveys.

RESULTS

The qualitative outcomes demonstrated that teamwork can be enhanced by improved visibility, while the quantitative findings supported the idea that some specific measures of visibility were correlated with teamwork.

CONCLUSION

This study provides a model for future research on the association between healthcare staff behavior and ED plan configuration. The enhancement of ED design, considering the significance of visibility, enhances the perceptions of nurses and physicians in terms of teamwork.

When the paediatric intensive care unit becomes home: A hermeneutic-phenomenological study

BACKGROUND

Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting.

AIM

This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes.

STUDY DESIGN

A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital.

METHODS

Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings.

RESULTS

Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments.

CONCLUSION

Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families.

RELEVANCE TO CLINICAL PRACTICE

This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.

Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout

OBJECTIVE

To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors.

BACKGROUND

There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied.

METHODS

Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory.

RESULTS

Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02).

CONCLUSIONS

Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.

A comparison of nurses' work satisfaction between single-room and multioccupancy adult intensive care units: A mixed-methods integrative review

OBJECTIVES

To systematically review and compare the evidence for the transition from multi- occupancy adult intensive care units to single room intensive care units.

REVIEW METHOD USED

A mixed methods systematic review informed by Joanna Briggs Institute guidelines for Systematic Reviews.

DATA SOURCES

The databases CINAHL, Medline and Embase were searched for primary research articles relating from 2008-2019.

REVIEW METHODS

The methodological quality of all studies that met the inclusion criteria were assessed using Mixed Methods Appraisal Tool (MMAT). The findings were synthesised into themes.

RESULTS

6349 records were identified, and four of those met the inclusion criteria and included in the review. Eight inter-related themes were revealed, which were teamwork, isolation, patient safety, proximity, staff education, satisfaction, staff morale and ambience.

CONCLUSIONS

When planning transitions from multi-occupancy to single room ICU's, although patient safety, and patient and family privacy are paramount, consideration should be also given to the nurse work environment and work satisfaction.

A comparative evaluation of Swedish intensive care patient rooms

OBJECTIVE

This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room "module," usually consisting of a pair of patient rooms and a joint location for monitoring and documentation.

BACKGROUND

Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas.

METHODS

Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires (n = 72), staff interviews (n = 9), and systematic observation (6 hours).

RESULTS

In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance.

CONCLUSIONS

The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance.

KEYWORDS

Critical care/intensive care, organizational transformation, outcomes, post occupancy, work environment.

Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of “Neighborhoods” in a Pediatric Intensive Care Unit

Objectives:

The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition.

Background:

In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “macrocognition in the healthcare built environment” (mHCBE) addresses this relationship.

Method:

A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data.

Results:

Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs).

Conclusions:

Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.

The Impact of Visibility on Teamwork, Collaborative Communication, and Security in Emergency Departments: An Exploratory Study

The aim of this study was to examine the influence of visibility on teamwork, collaborative communication, and security issues in emergency departments (EDs). This research explored whether with high visibility in EDs, teamwork and collaborative communication can be improved while the security issues will be reduced. Visibility has been regarded as a critical design consideration and can be directly and considerably impacted by ED's physical design. Teamwork is one of the major related operational outcomes of visibility and involves nurses, support staff, and physicians. The collaborative communication in an ED is another important factor in the process of care delivery and affects efficiency and safety. Furthermore, security is a behavioral factor in ED designs, which includes all types of safety including staff safety, patient safety, and the safety of visitors and family members. This qualitative study investigated the impact of visibility on teamwork, collaborative communication, and security issues in the ED. One-on-one interviews and on-site observation sessions were conducted in a community hospital. Corresponding data analysis was implemented by using computer plan analysis, observation and interview content, and theme analyses. The findings of this exploratory study provided a framework to identify visibility as an influential factor in ED design. High levels of visibility impact productivity and efficiency of teamwork and communication and improve the chance of lowering security issues. The findings of this study also contribute to the general body of knowledge about the effect of physical design on teamwork, collaborative communication, and security.

Usability evaluation (IEQ survey) in hospital buildings

Purpose

As hospital operations are undergoing major changes, comprehensive methods are needed for evaluating the indoor environment quality (IEQ) and usability of workspaces in hospital buildings. The purpose of this paper is to present a framework of the characteristics that have an impact on the usability of work environments for hospital renovations, and to use this framework to illustrate the usability evaluation process in the real environment.

Design/methodology/approach

The usability of workspaces in hospital environments was evaluated in two hospitals, as an extension of the IEQ survey. The evaluation method was usability walk-through. The main aim was to determine the usability characteristics of hospital facility workspaces that support health, safety, good indoor air quality, and work flow.

Findings

The facilities and workspaces were evaluated by means of four main themes: orientation, layout solution, working conditions, and spaces for patients. The most significant usability flaws were cramped spaces, noise/acoustic problems, faulty ergonomics, and insufficient ventilation. Due to rooms being cramped, all furnishing directly caused functionality and safety problems in these spaces.

Originality/value

The paper proposes a framework that links different design characteristics to the usability of hospital workspaces that need renovation.