A special report from Dr. Jack J. Sternlieb, reprinted from the Desert Sun Newspaper.
Hospital design has not changed in decades. In 1995, when I started designing the first heart hospital in California, with Adam Rubinstein of One Dream Design, I researched the literature in an attempt to build an ideal facility that would improve patient safety. Unfortunately, very little has been written on this topic. Federal and state agencies that regulate hospitals are mostly concerned with fire safety and earthquake protection. The only new construction requirements for hospitals mandated by California law SB 1953 addresses retrofitting older hospitals to current seismic regulations by the year 2008, which The Heart Hospital already conforms to. This will cost California hospitals billions in construction costs to meet this deadline. There is an increased awareness of hospital acquired injuries and errors causing morbidity and mortality recently made public by the Institute of Medicine in a report entitled "Building a Safer Health System" which indicated that 80,000 patients die per year from such causes. In response, President Clinton has mandated new regulations to address these issues. As a heart surgeon, I am a hospital based physician and have spent all my career working and visiting hospitals, such that I felt that improvement in design could lead to better outcomes for our patients.
The floor plan is perhaps the most important design element and can only be addressed with new construction. By using a hexagon configuration as exists in The Heart Hospital, or a circular design with the nursing station in the center, all rooms are equidistant from the staff. With this design, all rooms can be visible from the nursing station. Many hospitals have long corridors which places some rooms at a great distance from the staff. This makes it necessary to triage patients and place those that are more ambulatory and less ill in the distant rooms. All patient corridors are visible from the nursing station and there are no dead ends where patients cannot be seen while ambulatory. It has been shown that an ideal number of beds for a critical core unit is twelve. Big is not always better when it comes to taking care of acutely ill patients.
Our private guest suites with bathrooms and showers were designed to meet a patient's needs from admission to dismissal, thereby avoiding multiple room changes and stays in a ward such as recovery rooms. This multi-purpose suite similar to a birthing center concept was the first of its kind in the U.S.A. when opened in 1997, but now is being replicated in other new heart hospitals. Should a patient's condition deteriorate suddenly, then all the equipment needed is already built into the cabinetry, thereby avoiding a transfer to a critical care unit. This design allows for a comfortable and quiet environment, such that we have noted a virtual absence of confusion and disorientation known as ICU-itis. Heart patients are especially prone to sudden life-threatening events and therefore minute by minute monitoring is important rather than relying on sporadic "bed checks" during nursing rounds. At The Heart Hospital each suite has fully computerized monitoring capability which allows all vital signs including pulse, EKG rhythm, blood pressure, oxygen saturation, and temperature to be visualized in the room and simultaneously at the nursing station. If only the EKG is being monitored at the nursing station, many patient problems may be missed until a crisis develops. Elderly patients have a tendency, especially at night, to discontinue their oxygen and intravenous fluids, and by the time the heart rhythm is affected considerable valuable time may have elapsed.
Hospital acquired infections are of great concern especially with the rise of resistant bacterial, therefore private rooms and bathrooms decrease the likelihood of transmitting infections from one patient to another. In an effort to better sanitize and clean patient areas, our suites have tiled floors with sealed epoxy grout which is impervious to fluids. Carpets in patient rooms are hard to clean and disinfect. Recent studies have shown that both fungi and bacteria can grow in carpet and upholstery fabric. Linoleum when washed can harbor certain microbial organisms. By choosing mostly leather products, all of our furnishing can be deep cleaned regularly. Commodes, traditionally used in CCUs, are avoided as they are hard to keep clean, and our toilets are situated only a few feet from the bed.
The majority of hospital injuries occur due to falls from beds. Both the likelihood of falling and the severity of the injury increase with age. The average age of our patients is 74 years old, and falls in this age group have been associated with as high as a 50 % mortality in one year, for hip fracture. Fall-prevention interventions at The Heart Hospital involve using beds that have a built-in alarm system monitored in the room, and at the nursing station, using both visual and auditory signals to alert the staff that a patient is attempting to get out of bed without help. When this devise is used in combination with guard rails, falls can be decreased by an astounding 75%. Falls tend to occur in the first three days of a hospitalization when the patient is unfamiliar with the surroundings and may be early in the recovery from an operation. Most falls occur at night prompted by a need to use the bathroom and they are more frequent on medical-surgical floors where the nurse to patient ratio is lower therefore bed alarms are vital in these areas. Potential injuries in the shower are decreased by having built-in benches and grab bars.
Video cameras with night vision have been placed in each suite for added protection. These cameras can be adjusted from the nursing station to either give a panoramic view of the room or a zoom in on the patient to make sure that oxygen, catheters, and the like are not inadvertently discontinued by the patient.
A unique operating room, the only one of its kind in the Coachella Valley, was designed to allow angioplasties to be performed in the same room that a patient can undergo open heart surgery. This suite is used by cardiologists for all interventional procedures and the benefit is that should a patient's condition require immediate surgery it can be performed in the same suite without having to transport a critically ill patient through corridors or elevators to the operating area. Also, new hybrid procedures combining angioplasty and minimally invasive bypass surgery can be performed simultaneously in the same room, thereby adding to patient safety and convenience.
Most patients now being hospitalized are more acutely ill that they were a few years ago, and therefore safety in hospital design is very important. As a patient, you should feel confident that when you are in a hospital your safety is a top priority so as to allow you to recover in a protected environment.
Dr. Jack J. Sternlieb is Founder and President of The Heart Hospital and Director of Cardiovascular surgery. Should you wish further information, please e-mail firstname.lastname@example.org.