Insights & Solutions

Behavioral health settings guided by strict safety design measures often result in spaces that are stark, plain, and isolated - potentially exacerbating environmental stressors and escalating already difficult patient situations. Acute care emergency settings have a particular set of challenges as EDs are predicting increased visits from behavioral health patients. Faced with the challenge of designing a behavioral health care setting in the Emergency Department at UnityPoint Health in Rock Island, IL, the project team hypothesized that the creation of a Crisis Stabilization Unit (CSU) with a “Living Room Concept” would provide a higher quality of care to patients while assisting in the staff’s ability to quickly consult and treat a diverse set of patients entering the ED. 

This presentation provides information on the current incidence of healthcare-associated infections in U.S. hospitals and design & construction considerations that can help prevent these outcomes. Examples of published outbreaks related to design and construction activity are provided. In addition, specific examples of design options and construction risk mitigation measures will be reviewed. 

Patient falls are the most common adverse event reported in acute care settings, affecting from between 2% to 10% of annual hospital admissions. Patient falls cause increased morbidity, mortality, length of stay, and have significant cost impacts. One recent study examined the relationship of design factors in patient rooms to falls in 30 units in 15 hospitals. Results indicate key factors associated with higher numbers of falls, including multi-person rooms, shared toilet rooms, number and location of grab bars, and others. Explore the intrinsic and extrinsic factors on fall risk and the role design plays in mitigating these factors through real design solutions. 

The era of accountable care has focused more attention on doing things right. Hospitals are no longer reimbursed for what are categorized as "never events," serious adverse events that are largely preventable. The Center for Health Design, with support from the Facility Guidelines Institute and a grant from the Agency for Healthcare Research and Quality (AHRQ), has been working toward a consensus-based tool to proactively assess safety and risk in the built environment during the design process. New language will be incorporated into the 2014 Guidelines for the Design and Construction of Healthcare Facilities.

For the 2014 cycle of the Facility Guidelines Institute's health care design guidelines, a brand new volume is being developed for residential and senior living facilities; entitled the Guidelines for Residential Care Facilities: Design & Construction of Health, Care, and Support Facilities. This guideline includes nursing homes, hospice, assisted living, independent living, adult day care, and wellness/diagnostic facilities. The vetted approach to the guidelines is to provide design information, as well as parameters for Authorities Having Jurisdiction to evaluate and incorporate culture change and resident-centered approaches to the residential-based care. 

Developed through extensive review of research, surveys, site tests, and review and validation by expert advisory council members, this standard set of evidence-based design checklists and post-occupancy evaluation (POE) tools can be used by interior designers to apply research to healthcare design projects and to conduct post-occupancy evaluations of three types of hospital patient rooms: adult medical-surgical, adult intensive care, and maternity care.