New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools
Keywords:
Hospital ward; Healthcare Infrastructures; Wellbeing; Single Inpatient Room; Comfort; User Experience; post-COVID-19Abstract
Background. The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards.
Study Design. The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation.
Methods. A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project.
Results. Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed.
Conclusions. Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.
References
1. Anåker A, Heylighen A, Nordin S, Elf M. Design Quality in the Context of Healthcare Environments: A Scoping Review. HERD. 2017 Jul;10(4):136-150. doi: 10.1177/1937586716679404. Epub 2016 Dec 18.
2. Cambra-Rufino L, Brambilla A, Paniagua-Caparrós JL, Capolongo S. Hospital Architecture in Spain and Italy: Gaps Between Education and Practice. HERD. 2021 Jul;14(3): 169–181. doi: 10.1177/1937586721991520.
3. Shannon MM, Nordin S, Bernhardt J, Elf M. Application of Theory in Studies of Healthcare Built Environment Research. HERD. 2020 Jul;13(3):154-170. doi: 10.1177/1937586719901108
4. Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008 Spring;1(3):61-125. doi: 10.1177/193758670800100306.
5. Capolongo S, Gola M, Brambilla A, Morganti A, Mosca EI, Barach P. COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals. Acta Biomed. 2020 Jul 20;91(9-S):50-60. doi: 10.23750/abm. v91i9-S.10117v.
6. Creese J, Byrne JP, Conway E, Barrett E, Prihodova L, Humphries N. “We All Really Need to just Take a Breath”: Composite Narratives of Hospital Doctors’ Well-Being during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Feb 19;18(4):2051. doi: 10.3390/ijerph18042051.
7. Eijkelenboom A, Ortiz MA, Bluyssen PM. Preferences for Indoor Environmental and Social Comfort of Outpatient Staff during the COVID-19 Pandemic, an Explanatory Study. Int J Environ Res Public Health. 2021 Jul 9;18(14):7353. doi: 10.3390/ijerph18147353
8. Foley JA, Chan E, van Harskamp N, Cipolotti L. Comfort Always: The Importance of Providing Psychological Support to Neurology Staff, Patients, and Families During COVID-19. Front Psychol. 2020 Oct 22;11:573296. doi: 10.3389/fpsyg.2020.573296.
9. Gulwadi GB, Joseph A, Keller AB. Exploring the impact of the physical environment on patient outcomes in ambulatory care settings. HERD. 2009 Winter;2(2):21-41. doi: 10.1177/193758670900200203.
10. Alsawaf ES, Albadry AM. Principles for the Sustainable Design of Hospital Buildings. Int J Sustainable Development and Planning. 2022;17(6): 1797–1808. doi:10.18280/ ijsdp.170614.
11. Brand SL, Thompson Coon J, Fleming LE, Carroll L, Bethel A, Wyatt K. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review. PLoS One. 2017 Dec 4;12(12):e0188418. doi: 10.1371/journal.pone.0188418.
12. Brambilla A, Sun T zhi, Elshazly W, Ghazy A, Barach P, Lindahl G, et al. Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation. International Journal of Environmental Research and Public Health. 2021;18(21): 11478. https:// doi.org/10.3390/ijerph182111478.
13. Gola M, Brambilla A, Barach P, Signorelli C, Capolongo S. Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare. Ann Ig. 2020 Sep-Oct;32(5):549-566. doi:
10.7416/ai.2020.2375.
14. World Health Organization (WHO). Hospitals of the future: a technical brief on re-thinking the architecture of hospitals. Report number: WHO/EURO:2023-7525-4729269380, 2023. Available from: https://www.who.int/europe/ publications/i/item/WHO-EURO-2023-7525-47292-69380 [Last accessed: 2023 Dec 14].
15. Sadler BL, Berry LL, Guenther R, Hamilton DK, Hessler FA, Merritt C, et al. Fable hospital 2.0: the business case for building better health care facilities. Hastings Cent Rep.
2011 Jan-Feb;41(1):13-23. doi: 10.1002/j.1552-146x.2011. tb00093.x.
16. Stichler JF, Hamilton DK. Evidence-based design: what is it? HERD. 2008 Winter;1(2):3-4. doi: 10.1177/193758670800100201.
17. Brambilla A, Mangili S, Das M, Lal S, Capolongo S. Analysis of Functional Layout in Emergency Departments (ED). Shedding Light on the Free Standing Emergency Department (FSED) Model. Appl Sciences. 2022;12(10): 5099. doi:10.3390/app12105099.
18. Fotovatfard A, Heravi G. Identifying key performance indicators for healthcare facilities maintenance. J Build Engineering. 2021;42: 102838. doi:10.1016/j.jobe.2021.102838.
19. Dolcini M, Brambilla A, Gola M, Capolongo S. Health and well-being key performance indicators in corporate sustainability disclosure. A review of sustainability reports from a sample of major European companies. Acta Biomed. 2023 Aug 30;94(S3):e2023132. doi: 10.23750/abm. v94iS3.14334.
20. Capolongo S, Brambilla A, Girardi A, Signorelli C. Validation Checklist for Massive Vaccination Centers. Ann Ig. 2021 Sep-Oct;33(5):513-517. doi: 10.7416/ai.2021.2460. Epub 2021 Jun 11.
21. Clark T, Combs S. A Study of Hospital Inpatient Unit Design Factors Impacting Direct Patient Care Time, Documentation Time, and Patient Safety. The American Institute of Architects. 2017. Available from: https://www.healthdesign. org/system/files/Clark2C%20Combs-FY2008-09-A%20 Study%20of%20Hospital%20Inpatient%20Unit%20Design%20Factors%20Impacting%20Direct.pdfhttps://www. healthdesign.org/system/files/Clark2C%20Combs-FY200809-A%20Study%20of%20Hospital%20Inpatient%20 Unit%20Design%20Factors%20Impacting%20Direct.pd [Last accessed: 2023 Dec 14].
22. Bygstad B, Øvrelid E. Architectural alignment of process innovation and digital infrastructure in a high-tech hospital. Eur J Information Systems. 2020;29(3): 220–237. doi:10.1 080/0960085X.2020.1728201.
23. Joseph A, Rashid M. The architecture of safety: hospital design. Curr Opin Crit Care. 2007 Dec;13(6):714-9. doi:
10.1097/MCC.0b013e3282f1be6e.
24. Boubekri M, Cheung IN, Reid KJ, Wang CH, Zee PC. Impact of windows and daylight exposure on overall health and sleep quality of office workers: a case-control pilot study. J Clin Sleep Med. 2014 Jun 15;10(6):603-11. doi: 10.5664/ jcsm.3780.
25. Rossi A, Heyman NB, Rossi MO, Wolf S, White T. Exploring the Association Between the Healthcare Design Elements and Physician Well-Being: A Scoping Review. HERD. 2023 Jul;16(3):362-378. doi: 10.1177/19375867231151687. Epub 2023 Feb 1.
26. Stanhope J, Breed MF, Weinstein P. Exposure to greenspaces could reduce the high global burden of pain. Environ Res. 2020 Aug;187:109641. doi: 10.1016/j.envres.2020.109641. Epub 2020 May 8.
27. Ulrich RS. View through a window may influence recovery from surgery. Science. 1984 Apr 27;224(4647):420-1. doi:
10.1126/science.6143402.
28. Trau D, Keenan KA, Goforth M, Large V. Nature Contacts: Employee Wellness in Healthcare. HERD. 2016 Apr;9(3):47-62. doi: 10.1177/1937586715613585. Epub 2015 Nov 17.
29. Lu Y, Ossmann MM, Leaf DE, Factor PH. Patient visibility and ICU mortality: a conceptual replication. HERD. 2014 Winter;7(2):92-103. doi: 10.1177/193758671400700206.
30. Mead M, Ibrahim AM. Strategies to evaluate the quality of hospital design with clinical data. J Hosp Med. 2023 Jun;18(6):538-543. doi: 10.1002/jhm.12987. Epub 2022 Nov 7.
31. Mandato C, Siano MA, De Anseris AGE, Tripodi M, Massa G, De Rosa R, et al. Humanization of care in pediatric wards: differences between perceptions of users and staff according to department type. Ital J Pediatr. 2020 May 19;46(1):65. doi: 10.1186/s13052-020-00824-5.
32. Simonsen T, Sturge J, Duff C. Healing Architecture in Healthcare: A Scoping Review. HERD. 2022 Jul;15(3):315-328.
doi: 10.1177/19375867211072513. Epub 2022 Jan 12.
33. Giménez MC, Geerdinck LM, Versteylen M, Leffers P, Meekes GJ, Herremans H, et al. Patient room lighting influences on sleep, appraisal and mood in hospitalized people. J Sleep Res. 2017 Apr;26(2):236-246. doi: 10.1111/jsr.12470. Epub 2016 Nov 10.
34. Ander EE, Thomson LJ, Blair K. Using Museum Objects to Improve Wellbeing in Mental Health Service Users and Neurological Rehabilitation Clients. British J Occupational Therapy. 2013;76(5):208-216. doi:10.4276/030802213X13 679275042645.
35. Yu C, Yoon H. The Role of Colour in ‘Health and Wellbeing’ of the Built Environment. Indoor Built Environ 2010;19;4:403–404. doi: 10.1177/1420326X10378062.
36. Aalto L, Lappalainen S, Salonen H, Reijula K. Usability evaluation (IEQ survey) in hospital buildings. Int J Workplace Health Management. 2017;10(3): 265–282. doi:10.1108/ IJWHM-03-2016-0014.
37. Lindahl J, Thulesius H, Wijk H, Edvardsson D, Elmqvist
C. The Perceived Support From Light and Color Before
and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study. HERD. 2023 Apr;16(2):109-124. doi: 10.1177/19375867221150215. Epub 2023 Mar 2.
38. Lenaghan PA, Cirrincione NM, Henrich S. Preventing Emergency Department Violence through Design. J Emerg Nurs. 2018 Jan;44(1):7-12. doi: 10.1016/j.jen.2017.06.012. Epub 2017 Aug 1.
39. Mahmood FJ, Tayib AY. Healing environment correlated with patients’ psychological comfort: Post-occupancy evaluation of general hospitals. Indoor and Built Environment. 2021;30(2): 180–194. doi:10.1177/1420326X19888005.
40. Cusack L, Wiechula R, Schultz T, Dollard J, Maben J. Anticipated advantages and disadvantages of a move to 100% single-room hospital in Australia: A case study. J Nurs Manag. 2019 Jul;27(5):963-970. doi: 10.1111/jonm.12753. Epub 2019 Apr 21.
41. Sharma V, Caldas CH, Mulva SP. Development of metrics and an external benchmarking program for healthcare facilities. Int J Construction Management. 2021;21(6): 615–630. doi:10.1080/15623599.2019.1573490.
42. Mulva SP, Dai J. Healthcare facility benchmarking. HERD. 2009 Fall;3(1):28-37. doi: 10.1177/193758670900300104.
43. World Health Organization (WHO). Hospital Readiness Checklist for COVID-19. 2020. Accessible at https://www. euro.who.int/__data/assets/pdf_file/0010/430210/HospitalReadiness-Checklist.pdf [Last accessed: 2023 Dec 14].
44. Mangili S, Ciaffoni L, Sun T, Brambilla A, Capolongo S. Evaluation of stakeholder opinion about Long Term Care Facilities for People with Dementia perceived quality: a webbased survey in the Italian context. Acta Biomed. 2023 Aug 30;94(S3):e2023143. doi: 10.23750/abm.v94iS3.14283.
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