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The Environment of Inpatient Healthcare Delivery and Its Influence on the Outcome of Care

Originally Published:
2012
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Key Point Summary
Key Point Summary Author(s):
Gittler, Alice M.
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Key Concepts/Context

There is a growing body of evidence demonstrating that in all healthcare settings, the design of discipline-specific space can influence patients and their health outcomes. The contribution of the physical environment to quality of life and well-being is also supported. Healthcare delivery has changed over the last three decades; however, the authors note that some ICUs and emergency departments have not fully adapted to these changes, whereas palliative care and women’s health have adapted to include more family involvement and patient-driven changes. Environments such as labor and delivery units have benefitted from active consumer involvement in design. In this review, five themes were identified in the literature, including safety, privacy, a homelike environment, infection control, accommodating families, and nurse proximity to the patient. Findings related to each theme are summarized. Involvement of users, attention to particular care delivery needs, and attention to safety are also highlighted.

Objectives

This paper summarizes findings from healthcare, environment, and design research literature, examining commonalities and differences in the design and use of space across emergency department, intensive care, maternity, palliative care, care of the aged, and mental health settings, as well as highlighting the impact of the environment and space on outcomes for patients and families. 

Methods

Literature review. A general search of the full-text journal article database Ovid was conducted, using the words environment and design. A more focused search was then conducted using the search engines Scopus, PsycINFO®, CINAHL®, Medline, and Ovid and relating environment to particular healthcare environment terms (emergency department, intensive and critical care, maternity and midwifery, hospice and palliative care, care of the aged, and mental health) to determine the priorities and impact of environmental design in each setting. The words used in combination with environment were design, space, and outcomes. The review included English-language articles only. 

Design Implications
Family needs: Care provided to patients extends to their loved ones. As such, consideration of design that provides physical space for family members, privacy for patients and family members, and opportunities for interaction with clinical staff are encouraged. Patient privacy and single rooms: Single inpatient rooms are associated with lower infection rates and higher patient satisfaction due to greater privacy, less noise, more time with clinicians, more space for family, and greater control over the room environment (TV). Staff report better patient communication and the possibility for reduced error. Evidence is also emerging that in some environments of care (ICU, palliative care), private rooms can result in greater feelings of social isolation, and if those rooms are low-visibility, some studies indicate the potential for negative outcomes for very ill patients. Medical technology: Technology placement and use should ensure that the focus remains on the patient. Locating technology at the bedside is advantageous because it facilitates closer monitoring. Appropriate space and time for the personal aspects of care should be balanced with technology needs and locations. Patient Safety: Maximize the potential for a safe and therapeutic clinical environment not only for the patient, but also for visitors and staff. The use of curtains (privacy and infection), mattresses (bed sores), acoustical needs, special needs of the behavioral health environment, and adequate space around the patient bed are all important considerations. Involve patients, families, and staff actively in design of environments of care.
Findings

Despite the diversity of patient care settings, the literature revealed several common themes that highlight factors that influence and contribute to the design of healthcare settings, including: (1) design of physical space, (2) accommodating family needs as key to patient’s healing, (3) balancing privacy considerations with infection control and social needs, (4) the use of technology as a tool to improve health and still retain a patient focus, and (5) patient safety. 

Research supporting the influence of environmental details on healthcare delivery and patient outcomes in rapidly changing healthcare environments provides useful guidance, especially in tertiary environments, where some settings have outgrown their initial purpose and are in need of redevelopment. 

There is growing evidence that active involvement of users, attention to particular care delivery needs, and attention to safety in some environments of care are leading to better outcomes.

No evidence was identified that focused on the involvement of service users in the design of inpatient spaces.

Key Point Summary Author(s):
Gittler, Alice M.
Primary Author
O'Connor, M.
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