A Review of the Research Literature on Evidence-Based Healthcare Design
Ulrich, Roger S., Zimring, Craig, Zhu, Xuemei, Ms, Jennifer, Seo, Hyun-Bo, Choi, Young-Seon, Quan, Xiaobo, Joseph, Anjali, HERD : Health Environments Research & Design Journal
Objective: This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.
Background: It builds on a literature review conducted by researchers in 2004.
Methods: Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.
Results: This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.
Conclusions: The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.
Key Words: Evidence-based design, hospital design, healthcare design, healthcare quality, outcomes, patient safety, staff safety, infection, hand washing, medical errors, falls, pain, sleep, stress, depression, confidentiality, social support, satisfaction, single rooms, noise, nature, daylight
A visit to a U.S. hospital is dangerous and stressful for patients, families, and staff. Hospital-acquired infections and medical errors are among the leading causes of death in the United States, each killing more people than automobile accidents, breast cancer, or acquired immune deficiency syndrome (AIDS) (Institute of Medicine [IOM], 2001; Klevens, et al., 2007a). The resulting yearly cost for U.S. hospitals is estimated to be $5 billion for hospital-acquired infections (Centers for Disease Control and Prevention [CDC], 2000) and $17- to $29 billion for medical errors (Kohn, Corrigan, & Donaldson, 1999). According to the IOM (2001) in its landmark Crossing the Quality Chasm report: "The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits" (p. 1). Problems with U.S. healthcare not only negatively influence patients; they affect staff. Registered nurses have a turnover rate averaging 20% (Joint Commission, 2002).
At the same time, a major boom in hospital construction is occurring in the United States and several other countries. The U.S. healthcare system is facing the confluence of the need to replace aging 1970s' hospitals, population shifts, the graying of the Baby Boom generation, and the introduction of new medical technologies. As a result, the United States will spend more than $180 billion for new hospitals in the next 5 years alone, and healthcare construction is projected to exceed $70 billion per year by 2011 (Jones, 2007). These new hospitals will remain in place for decades.
This once-in-a-lifetime construction program provides an opportunity to rethink hospital design and especially to consider how better design can improve patient and staff outcomes. Just as medicine has increasingly moved toward evidence-based medicine where clinical choices are informed by research, healthcare design is increasingly guided by rigorous research linking hospitals' physical environments to healthcare outcomes, and it is moving toward evidence-based design (EBD) (Hamilton, 2003). …