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Evaluation of Functional & Environmental Factors in Spanish Acute-care Hospital Design "Evaluación de los factores funcionales y ambientales en el diseño de hospitales de agudos españoles"
Abstract
The aim of this doctoral thesis is to explore the evaluation of functional and environmental factors in acute-care hospital design that might have an impact on healthcare outcomes. Despite the progress of the evidence-based design process in North-European and North American countries, in Spain it still has not been fully developed. The purpose of this design process is to establish a link between design variables and health-related outcomes. Acutecare hospitals are buildings in constant change to cope with the evolving demands of clinical progress and the social context. Thus, acknowledging the functional and environmental factors that impact on the care process and evaluating them in existing acute-care hospitals becomes of paramount importance. This dissertation follows a mixed-method methodology based on four perspectives: 1) the field, with an ethnographic study during a three-month placement in an acute-care hospital; 2) the theory, with literature analysis; 3) the future, with an ethnographic study of sixteen acute-care hospital visits considered as best practice, and 4) the present, with the evaluation of four acutecare hospitals in Spain. The primary result of this work is the tool CURARQ. The purpose of this tool is, on the one hand to provide a first diagnostic of the functional and environmental quality of the studied unit, and on the other hand to guide in the design decision process of a new development. This tool has been created for seven units in the acute-care hospital and has been tested in four acute-care hospitals in “Comunidad Valenciana”. Secondary results include: 1) feedback and scripts from users during the acute-care hospital placement; 2) evaluation through architectural layouts and photographs of the acute-care hospital visits; and 3) evaluation of CURARQ scores of the four evaluated acute-care hospitals. This document provides a current overview of functional and environmental factors in acutecare hospitals, which evidence: 1) the need for refurbishment to promote clinical innovation; 2) the need to update national standards, 3) the usefulness of CURARQ tool to identify priority buildings to intervene, and 4) the usefulness of CURARQ tool to generate synergies between healthcare staff, patients, researchers, and architects to promote the potential of the evidencebased design process in Spain.
... Asylums were conceived integrated in a major landscape, with big extensions of ornamental gardens, for walking and entertainment. Meanwhile, the Hygienist Movement (1920) and new trends in urbanism included ideas like the machine à habiter from Le Corbusier that were applied to hospitals too, and progressively, these buildings -as well as were conceived as dense and high structures -are isolated from nature, even visually (Cambra Rufino, 2021). ...
This study aims to identify what factors influence the use of public spaces by older adults in two European cities, Madrid (Spain) and Newcastle upon Tyne (United Kingdom), through a mixed methodology based on environmental measurements, surveys and direct observation in open public spaces. There are significant differences between the two case studies in terms of permanence, frequency of use and activities. In Madrid, older adults correspond to 22.33% of the users; most of them visit those spaces daily and perform more physical activities, while in Newcastle, they represent 37% of the users; most of them perform passive activities and stay longer than in Madrid. It was found that some environmental factors such as air temperature, humidity, noise level and wind speed, as well as some design elements and the subjective perception of acoustic and thermal comfort, have a statistical influence on the permanence of older people. Although these are cities with different characteristics in size, climate, culture and urban structure, in both cases, older adults correspond to a high percentage of the users of open public spaces. An adequate design that promotes their health and quality of life is important, taking into account their needs and preferences to support active ageing.KeywordsUse of public spacesOlder adultsOpen public spacesActive ageingHealthy ageingPopulation ageing
Mental health problems have become one of the major public health concerns in many countries affecting all ages and sectors of the population. From depression to dementia or anxiety, mental health in urban environments is a consequence of a stressful lifestyle as well as many other factors, where the environment where people live is directly related. In this context, green and natural spaces play a major role to increase quality of life and well-being. The relation between care homes or mental health institutions has been historically related directly with green spaces. In this research is presented the relation between green infrastructure and the centres for older people in the district of Usera in the city of Madrid, as well as the urban environment where they are located. In total, 14 centres of the district of Usera in the south of Madrid have been analysed. The aim was to evaluate the current situation of this kind of municipal equipment and to understand the current challenges and opportunities of the existing built environment to create friendly healthier and more inclusive environments. The results show the lack of connectivity and accessibility with green spaces and the challenges of zoning in a district of the consolidated city. Most of the centres that have been studied include a green space inside its limits; however, these spaces are disconnected from the surroundings and are usually kept as decorative elements. The discussion highlights the need of a more multidisciplinary approach to plan urban spaces and the cities, integrating in a coherent strategy the concepts of sustainability, green infrastructure and age-friendliness.KeywordsMental healthGreen spacesOutdoorCare homes
Purpose – Several healthcare quality assessment tools measure the processes and outcomes of the care system. The actual physical infrastructure (buildings and organizational) aspects are, however, rarely considered. The purpose of this paper is to describe the process of validation and weighting of an evidence- informed framework for the quality assessment of hospital facilities from social, environmental and organizational perspectives to complement other assessments.
Design/methodology/approach – Sustainable High-quality Healthcare version 2 (SustHealth v2) is the updated version of an existing framework composed of three domains (social, environmental and organizational quality). To validate and establish a relevant weighting, interviews were conducted with 15 professionals within the field of healthcare planning, design, research and management. The study has been conducted through semi-structured interviews and the application of the Simon Roy Figueras (SRF) procedure for the elicitation of weights criteria. The data collected have been processed through the DecSpace web platform.
Findings – Among the three domains, the organizational qualities appear to be the most important (W = 49%), followed by the environmental (W = 29%) and social aspects (W = 22%). Relevant indicators such as future-proofing, wayfinding and users’ space control emerged as the most important within each macro-area. Those results are confirmed by the outcome of the interviews that highlight user/patient-centeredness, wayfinding strategies and space functionality as the most important concepts to foster in existing healthcare facilities improvement.
Practical implications – The study highlights important structural and organizational aspects that hospital managers and planners can consider when dealing with healthcare facilities’ quality improvement.
Originality/value – The use of the SRF multicriteria method is novel in this context when used to weight an assessment tool with a focus on hospital built environment.
Abstract Background An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/design Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding
Background and aim of the work:
World Health Organization states that is possible evaluating projects' qualities via Health Impact Assessment (HIA) but there are not specific HIA tools on hospital buildings assessment. Researchers show significant relationships between built environment and health. The research purpose is investigating how existing tools for healthcare building assessment are encouraging the development of possible hospital HIA evaluation.
Methods:
Based on previous works, 13 assessment tools have been included and a comparison of the criteria has been conducted to understand which the most prevalent topics are. The tools have been analyzed through literature, technical manuals and official websites. The authors identified 12 thematic categories where criteria from different tools have been clustered and discussed.
Results:
The most prevalent criteria are related to Indoor Environmental Quality (IEQ) (20%). In the oldest tools the evaluation was mainly on technical features while in recent instruments several indicators are related to Architectural features and innovation (48%), Education (23%) and Food (11%).
Conclusions:
There is growing interest in tools capable of addressing healthy hospitals encouraging IEQ, physical activity and healthy food provision related to occupants' health outcomes. This preliminary study set the basis for further development on hospital facility HIA tools.
Purpose:
Patient safety has developed as a strong marker for health care quality. Safety matters are important in the intensive care unit (ICU) where complex clinical decisions are made, intensive technology is used, and families hold a unique role. The aim of this review was to identify and describe factors that influence family member's perceptions of safety in the adult intensive care unit.
Data sources:
Searches were conducted during September - November 2018, and repeated July 2020 using CINAHL, MEDLINE (EBSCO), PubMed, and PsycINFO databases.
Study selection:
Published primary studies undertaken in adult ICUs and involving adult family member participants exploring safety or feeling safe. No date restrictions were applied.
Data extraction:
A data extraction form collected information about sample, study design, data collection methods and results from each paper. Methodological quality was assessed using the QualSyst tools for qualitative and quantitative studies. Narrative synthesis was undertaken.
Results of data synthesis:
Twenty papers were included with 11 papers published since 2010. The majority of papers reported on qualitative studies (n=16). Four factors were identified that influenced whether family members felt that the patient was safe in ICU: family visiting, information and communication, caring, and professional competence.
Conclusion:
In detailing specific practices that make families feel safe and unsafe in ICU, these review findings provide a structure for clinicians, educators and researchers to inform future work, and gives opportunity for the family role in patient safety to be reconsidered.
Today, Coney Island is known for family fun andentertainment. But few people realize that at onetime it was home to the first infant incubators in thenation. By examining the history of these incubators, putting children on display without their directconsent, and the psychology of cute, the authorsdelve into the darker side of Coney Island’s history.
The environment of care has a lasting impact on the patients, families, and caregivers who experience it. A newborn intensive care unit (NICU) is typically in use for 10–30 years, over which time decisions made during its design will have human and financial impacts far beyond the initial cost. Good planning is crucial, yet most participants in the planning process have little experience designing a NICU and may be driven as much by what they do not like in their existing NICU as by the evidence and experience reported by others. Standards generated by a group of experts in multiple disciplines can inform these planners, as well as the agencies developing building codes for NICUs. Now in its ninth iteration, these Recommended Standards continue to be refined as new evidence and experience accumulates, along with new guidance for couplet care in the NICU and for detection of latent safety risks prior to occupancy.
Background
While the impact of the intensive care environment on patients’ experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing.
Objective
The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians’ views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members.
Methods
A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach.
Results
Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients’ mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting.
Conclusions
Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.
Objective
Many patients admitted to an intensive care unit (ICU) are unable to make ongoing decisions of care for themselves during their ICU stay. The perspectives of families and other nominated decision makers are particularly important in forming a partnership with clinicians to provide effective person-centred care. The aim of this study is to evaluate family satisfaction with care in the ICU in regional NSW, Australia, and explore the relationship between the level of satisfaction and family characteristics.
Methods
A cross-sectional survey design was conducted in two ICUs in regional NSW, Australia, using a validated family satisfaction questionnaire. The Family Satisfaction in the Intensive Care Unit survey calculates an overall family satisfaction score (FS-Total) and two subscales, measuring family satisfaction with care (FS-Care) and family satisfaction with decision-making (FS-DM).
Results
A total of 104 family members were surveyed, with a 53% response rate. The mean FS-Total score was high (85.58, standard deviation [SD] = 14.6), with FS-Care (92.94, SD = 15.71) ranked higher than FS-DM (81.84, SD = 19.16). Significant differences in mean FS-Total and FS-DM scores were reported by the partners/spouses (p = 0.009 and p = 0.003, respectively) and those who lived with the patient (p = 0.039 and p = 0.011, respectively). Levels of satisfaction were also impacted by communication, waiting room facilities, and visiting times.
Conclusions
Opportunities exist to further explore and improve family satisfaction with care in ICUs in regional NSW, Australia, particularly for spouses and partners and those who co-reside with the patient. Developing family-friendly clinical spaces and waiting rooms that allow family privacy along with amenities that support comfort and rest throughout their ICU experience may improve satisfaction levels.
Background:
Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings.
Aim:
The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales.
Methods:
A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy.
Findings:
The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings.
Conclusion:
In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.