Hospital Makeovers

March 3, 2010 Written by JP       [Font too small?]

I happened to hear a segment on the radio program “Marketplace” while driving in my car the other day. The piece that caught my attention was entitled, “The Cure: Remaking Health Care”. The focus of this National Public Radio report was the San Diego-based Sharp Memorial Hospital, a $200 million facility that was built using the principles of “evidence-based design”. But can design alone be responsible for improving health outcomes in patients and saving millions, maybe even billions in healthcare costs down the line?

In the past, the number one fear that patients had when entering a hospital was that something would go awry during a surgical procedure. Nowadays there’s a very different concern that often weighs heavily on the minds of those being treated and by health care providers: hospital-acquired infections (HAI). The Centers for Disease Control and Prevention estimate that HAIs add somewhere between $28.4 – $45 billion dollars to annual health care costs in the United States alone. Most administrators and doctors understand this problem all too well, but few seem to be aware of viable solutions. Perhaps that is starting to change. Dan Gross, the executive vice president of Sharp Healthcare, recently explained some of the evidence-based design features that currently sets Sharp Memorial apart from most other hospitals. (1,2)

  • Sharp Memorial employs separate elevators for the public and patients. This helps to reduce exposure to germs that may result in infections in patients with compromised immune function. The use of “superior air filtration” and “antimicrobial coating on all ductwork and design elements” such as “blinds inlaid in glass” also help to prevent HAIs.
  • Nurses have a private “off stage” area where they can focus on preparing medications without distractions and outside interference. A more peaceful atmosphere translates into fewer medication errors.
  • This unique hospital doesn’t utilize loud speakers or medical carts that are typically shuttled from room to room. This promotes a sense of greater tranquility for both patients and staff and further decreases the transmission of germs.
  • Every patient has a private room which allows them to sleep better and affords a greater sense of privacy when communicating with doctors and nurses. All rooms are equipped with pull-out sofas for family members, private bathrooms and a free, wireless Internet connection.
  • The sensory design of the hospital is centered around the individual needs of patients and visitors as well. “Well balanced lighting, noise-reducing materials and provisions allowing patients to have some control over key environmental factors such as lighting levels, plus utilization of natural colors and materials that contribute to an environment of healing”.
  • Multiple storage spaces are located throughout the hallways to store medical equipment and supplies. This allows nurses and staff to spend more time with patients and less time walking longer distances to retrieve utilities.
  • There is a “jade” meditation garden on the hospital grounds. It was designed by “an 85-year old Japanese gardener” to serve as a place for reflection and stress relief for family members and patients alike.
  • 700 pieces of nature-based artwork adorn the walls of hospital common areas and patient rooms. Large windows and “soft, warm colors are used on walls, floors and furnishings”. The goal is to “incorporate the outside world” rather than constantly remind patients and visitors that they’re in a medical institution.

This all sounds pretty fancy and expensive, doesn’t it? That all depends on how you look at the issue of health care spending, according to Blair Sadler of the Institute for Healthcare Improvement. “If something costs an additional million dollars once and reduces operating costs by half-a-million dollars year after year, the payback becomes pretty obvious”. (3)

Source: Arch Intern Med. 2010;170(4):340-346. (Link 1,Link 2)

The issue of cost is a stubborn matter indeed. But it doesn’t always play out the way you might think. A recent comparison in the Archives of Internal Medicine determined that quality of care scores were decidedly mixed when looking at patient outcomes in lower cost hospitals and higher cost hospitals. For instance, the more expensive hospitals did provide slightly better care for patients with congestive heart failure, but they fared worse than less expensive hospitals in terms of treating pneumonia. The authors of the study concluded that, “Most evidence did not support the ‘penny wise and pound foolish’ hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care”. (4,5)

Organizations such as The Center for Health Design and the previously mentioned Institute for Healthcare Improvement (IHI) are ready and willing to assist in the creation of new healing environments that incorporate smarter spending of funds and resources. According to the IHI website, their goal is to promote “Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity” through evidence-based design. However their good intentions will go to waste if medical administrators are unaware of their existence. (6,7)

I wish that I personally had the power to bring about truly substantive changes in the current hospital system. There are so many areas of in-patient care that are in desperate need of improvement. When I visit someone in the hospital and see the type of food they’re given to eat, I shudder. It’s so incredible to me that some health professionals simply don’t seem to know any better. But as an old boss of mine used to say, “It is what it is”. But what it is now doesn’t have to be forever. One day most of us will likely end up in a hospital for one reason or another. If and when we do, we will certainly want to wind up in someplace like Sharp Memorial.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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5 Comments & Updates to “Hospital Makeovers”

  1. anne h Says:

    Sound like a great place – too good to be true? Or the next trend in health care?
    Many of these things I already see here and there…..
    Thank goodness it’s coming around.

  2. JP Says:

    Hopefully a trend, Anne. Perhaps it will be part of the much discussed health care reform? One can only hope. :)

    Be well!

    JP

  3. Nina K. Says:

    Good Morning JP :-)

    wow, i think everybody wishes a hospital like that. Great idea. I would like to see the jade garden :-) .

    Preventing HAI’s isn’t so difficult but the people working in hospitals are sometimes not really interested in changing their behavior. I worked in hospitals too few years ago and even the doctors which where on their tour on visit from patient to patient didn’t washed or disinfected their hands :-( so the germs went along….

    Greetings,
    Nina K.

  4. JP Says:

    Good day, Nina!

    I love the idea of the jade garden as well. Even patients that can’t go outside can enjoy its beauty by looking out the windows at it.

    There’s really no replacing common sense methods for reducing germ transmission such as hand washing. The trick is to establish definite guidelines about how and when it should be done. That will shift the focus from a subjective sense of when disinfecting/washing should be practiced and when it’s officially required – based on a consistent set of rules.

    Be well!

    JP

  5. JP Says:

    Updated 07/30/16:

    http://onlinelibrary.wiley.com/doi/10.1111/apt.13740/full

    Aliment Pharmacol Ther. 2016 Jul 28.

    Randomised clinical trial: a Lactobacillus GG and micronutrient-containing mixture is effective in reducing nosocomial infections in children, vs. placebo.

    BACKGROUND: Nosocomial infections are a major public health issue and preventative strategies using probiotics and micronutrients are being evaluated.

    AIM: To investigate the efficacy of a mixture of Lactobacillus GG and micronutrients in preventing nosocomial infections in children.

    METHODS: A randomised, double-blind, placebo-controlled trial was conducted in hospitalised children. Children (6 months to 5 years of age) received Lactobacillus GG (6 × 109 CFU/day) together with vitamins B and C and zinc or placebo, for 15 days, starting on the first day of hospitalisation. The incidence of gastrointestinal and respiratory nosocomial infections after discharge was determined by follow-up telephone call at 7 days. After 3 months, another telephone call estimated the incidence of further infections during follow-up.

    RESULTS: Ninety children completed the follow-up. Of 19/90 children with a nosocomial infection (20%), 4/45 children (9%) were in the treatment group and 15/45 (33%) in the placebo group (P = 0.016). Specifically, 2/45 (4%) children in the treatment group vs. 11/45 (24%) children in the placebo group (P = 0.007) presented with diarrhoea. The duration of hospitalisation was significantly shorter in the treatment group (3.9 days ± 1.7 vs. 4.9 ± 1.2; P = 0.003). At the follow-up, a total of 11/45 (24.4%) children in the treatment group had at least one episode of infection compared to 22/45 (48.9%) in the placebo group (P = 0.016).

    CONCLUSION: A mixture containing Lactobacillus GG and micronutrients may reduce the incidence of nosocomial infections, supporting the hypothesis that this may represent a valid strategy to prevent nosocomial infections.

    Be well!

    JP

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