By Evan Hicks / Special to Healthcare Facilities Today

Amid the change and uncertainty roiling healthcare, professionals need an effective way to future-proof their facilities.

Evidence-based design (EBD) is proving to be an ideal elixir. The approach of anchoring design decisions on credible research to produce the best results is palpably helping healthcare facilities improve patient outcomes while lowering costs.

Remedies may be as basic as rearranging bathroom layouts, letting in more natural light or providing personalized medication cabinets.

Benefits include boosting patients’ quality of care, safety and satisfaction while reducing medication use, readmission rates and facility costs.

And EBD typically provides a high and quick ROI. The AHRQ analysis on “Transforming Hospitals: Designing for Safety and Quality” reported that features costing a hospital $12 million were expected to be recouped in a year, thanks to operational savings and higher revenue. EBD has introduced a simpler design process, saving staff time, reducing risks, and generating efficiencies.

Resolving critical issues

The AHRQ report credits EBD with helping healthcare facilities turn the corner on such persistent challenges as:

• Hospital-acquired infections: These infections can prolong a hospital stay by  eight to nine days and cost facilities almost $10 billion a year in treatment, frequently without insurance reimbursement.

• Patient falls: Falls for the elderly population alone will surpass $30 billion annually by 2020, AHRQ projects.

• Medication mistakes: Human error is responsible for many of the adverse drug events that result in deaths or extended recovery periods. It’s estimated that hospitals lose as much as $5.6 million per year on average due to medication blunders, in addition to reputational damage.

EBD in action

How can EBD solutions address these issues? Let’s look at some examples.  

Increasingly, healthcare facilities are providing private rooms, in part because they help stem the spread of infections. Each exposure to a new hospital roommate increases the risk of acquiring certain infections by 10% or 11%, studies have found. In the five years after Montreal General Hospital opened a single-occupancy-only ICU, infection rates for MRSA, C. diff, and vancomycin-resistant Enterococci decreased to 54% below those at a nearby hospital’s similar ICU with both private and shared rooms.

Besides preventing infections, private rooms in an acuity-adaptable model of care also have yielded other advantages to Dublin (Ohio) Methodist Hospital. Dublin keeps patients in the same room until discharge, regardless of their treatment. The hospital has flexible rooms rather than separate medical, surgical and ICU areas. Nurses and medical equipment are brought to the patients. Among the additional benefits of having a single room and staying in one place, patients experience fewer falls, better sleep, and a quieter environment for family visits and recovery.  

Given the debilitating and costly consequences of falls, hospitals and long-term care facilities are investing in design improvements to avoid them. Science is on their side. Debajyoti Pati, a professor in the College of Human Sciences at Texas Tech University, Lubbock, led a research project to observe and capture the motions of participants over 70 years old as they navigated a model hospital room and bathroom. (The participants wore harnesses to avert falls and injuries.) The study found pushing, pulling, turning and grabbing were most likely to trigger falls. Bathroom configuration, bathroom doors, toilet seats, grab bars, toilet flush handles, and obstructions on the route to the bathroom all contributed. Among the recommended enhancements was to design a bathroom to minimize turns.  

Another important way to reduce falls, as well as medication use, is to enhance lighting. The Center for Health Design determined in a study that views of the outdoors can alleviate patient pain – for example, by evoking positive emotions and providing distractions. These effects led to less use of medication, resulting in a 21% decrease in medication costs, shorter hospital stays and higher hospital reimbursement potential.

Medication administration also is a common source of errors. An EBD solution to combat that problem calls for decentralizing medication storage and equipping each patient room with a small, locked cabinet for medication. This way, pills and other medications can be administered more efficiently and accurately, reducing chances of mixing up patients’ prescriptions. Clarian Health Partners saw medication mistakes plummet almost 70% after it replaced its multi-level ICU with variable acuity-adaptable rooms, each with its own locked medication cabinet. That was in addition to a 90% reduction in patient transfers and a decline in hospital expenses.

Steps to launch EBD

With so much to gain, EBD is worth serious consideration for every healthcare facility. 

How to get the ball rolling? According to The Center for Health Design, a facility needs to take these steps:

• Define evidence-based goals and objectives.

• Find sources for relevant evidence.

• Critically interpret relevant evidence.

• Create and innovate evidence-based design concepts.

• Develop a hypothesis.

• Collect baseline performance measures.

• Monitor implementation of design and construction.

• Measure post-occupancy performance results.

What else can you do to make EBD work?

First, build the proper foundation. Inspire your staff to board the EBD train and engage stakeholders – all focused on value. Create a diverse team, bringing together architects, designers, construction professionals, facility managers, C-suite executives, support services professionals, patients, caregivers and advocacy groups.

For best results, coordinate design enhancements with clinical and operational process enhancements. 

Then, as changes are implemented, get ready for continuous improvement in quality, safety, the patient experience and cost savings. Once everyone starts witnessing the outcomes, you’ll be glad you took the time and effort to fortify your facility for the exciting but challenging healthcare environment of tomorrow.   

Evan Hicks is Marketing Manager for the Senseon Secure Access business segment of Accuride International.