bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Evaluation of the Impact of the Planetree Patient-Centered Model of Care on Inpatient Quality Outcomes
Authors: Stone Susan 
Published: February 2015

Objective: This retrospective quasi-experimental study evaluated the Planetree patient-centered model of care on inpatient quality outcomes. The research questions to be addressed were: What is the impact of the Planetree patient-centered model of care (1) on patient satisfaction, (2) on clinical outcomes (length of stay and readmission), and (3) on the cost of providing care (cost per case and productive nursing hours per patient day)? Background: Patients and their families have described a more patient-centered approach as key to meeting their needs. The Planetree model of care provides a framework and operational guidance on how to implement programs targeting these key areas. The link between patient-centered care and quality outcomes such as patient satisfaction, length of stay, readmission, cost per case, and productive nursing hours per patient day has been postulated; however, to date little to no research has been conducted examining this issue. Methods: This was a retrospective, nonexperimental comparison study evaluating units with the same types of patients and the same skill mix, and with standardized organizational pay rates, supply costs, policies, procedures, contracts, and a regulatory compliance program. This provided a unique opportunity to evaluate the impact on inpatient quality outcomes of the Planetree patient-centered model of care as practiced in the Planetree unit. Data were analyzed using a 2 × 5 analysis of variance (ANOVA) and logistic regression (readmission only). This was a study of five separate cohorts grouped by calendar year rather than a study of repeated measures. Results: No differences in demographic profiles were noted between the two groups. The patient satisfaction composite mean score evaluation, length-of-stay evaluation, and the cost-per-case evaluation demonstrated that the Planetree group was different from the comparison group ( p = <.05 with Eta squared = >.01). This evidence validates that the Planetree patient-centered model of care had a positive impact on patient satisfaction, length of stay, and cost per case. Conclusions: This evaluation of 869 hospitalized adults undergoing elective total-knee or total-hip joint replacement surgery indicated that the Planetree patient-centered model of care positively affected patient satisfaction, length of stay, and cost per case. Nursing and hospital administrators seeking to improve the inpatient hospital experience should consider implementation of the Planetree patient-centered model of care. Hospitals and healthcare organizations seeking an evidence-based approach to the implementation of patientcentered care will benefit from the information in this study.
Searching for Evidence
Authors: Edelstein Eve A. 
Published: February 2015

Purpose: There is a clear call for a single-source knowledge base linking literature on architecture and human outcomes. However, this seemingly simple need relies upon a vast source of information from multiple disciplines, each with their own vocabulary, structures, and modes of disciplinary thought. Background: The “Information Age” provides an abundance of research from the sciences as well as the humanities. Despite unprecedented access via public and licensed databases, searching across knowledge repositories remains a labor-intensive and skilled task. It therefore behooves the design profession to collaborate with experts in research, and to seek new skills for searching, interpreting, and applying evidence to design. Methods: The pattern of database usage by 71 professionals involved with evidence-based design in healthcare facilities was studied. Respondents represented a range of interests including healthcare practitioners and executives, researchers, and design professionals. Findings: Survey analysis revealed that a large number of information repositories are used (45), though few sources were used in common among the respondents. Recommendations: Knowledge informatics strategies are reviewed, and concepts put forward advocating the design of an information source with multiple portals, vocabularies, and outputs to serve design, research, and healthcare practitioners alike.
Humane Design for Hospital Landscapes: A Case Study in Landscape Architecture of a Healing Garden for Nurses
Authors: Naderi Jody Rosenblatt , Shin Woo-Hwa 
Published: February 2015

Objective: The overall goal of this study was to design a beautiful garden to provide a spatial experience of renewal for hospital nursing staff and for their ecologically- and culturally-specific healing. The first objective of this study was to identify the physical, social, and spiritual attributes of an existing courtyard to determine which features encouraged or discouraged use. A site-specific design concept and user-specific survey instrument were developed to gather data directly from the nursing staff on campus. Background: There has been growing evidence that landscapes for renewal have measurable characteristics. Physical, social, and spiritual characteristics of the landscape interrelate to determine the appropriateness of a landscape for a particular health outcome. Increasingly, evidence demonstrates that contact with the living world around us is an important part of healing and recovery. This design project created a natural opportunity to research the effect of landscape improvements on renewal. Methods: The method combined standard landscape architecture ecological site design process with a qualitative empirical study of staff characteristics and landscape preferences. The transparency of the landscape design process provided the basis for a post-occupancy evaluation in the future. Results: Sixty-one nurses participated in the qualitative phase of the design process. Preferences for contact with nature and privacy were significant among the staff. The spatial structure of the concepts was revised to include private table-and-chair places for one or two people and features that would encourage a contemplative pedestrian walk along existing shortcuts. To encourage the benefits of the typical staff's very short exposure to the garden, archetypal landscape features—thresholds, contemplative paths, garden benches, a symbolic creek, and sacred springs—were arranged to shift the spiritual dimension of the place from that of an exposed, dry gulley ravine to a green, fertile oasis. Conclusions: The courtyard was designed based on survey results. The final design was reviewed and found to satisfy the preferences of the nursing staff. Currently, the design is being detailed for construction, and a post-occupancy evaluation is being developed to ascertain the quality of the outcome for the nurses.
Unit-Related Factors That Affect Nursing Time with Patients: Spatial Analysis of the Time and Motion Study
Authors: Hendrich Ann , Chow Marilyn P. , Bafna Sonit , Choudhary Ruchi , Heo Yeonsook , Skierczynski Boguslaw A. 
Published: February 2015

Objective: The primary goal of this study was to test the hypothesis that nurses adopt distinct movement strategies based on features of unit topology and nurse assignments. The secondary goal was to identify aspects of unit layout or organization that influence the amount of time nurses spend in the patient room. Background: Previous research has demonstrated a link between nursing hours and patient outcomes. Unit layout may affect direct patient care time by determining aspects of nurse behavior, such as the amount of time nurses spend walking. The recent nurses' Time and Motion study employed multiple technologies to track the movements and activities of 767 medical-surgical nurses. With regard to unit layout, initial analysis of the data set did not detect differences between types of units and time spent in the patient room. The analysis reported here applies novel techniques to this data set to examine the relationship between unit layout and nurse behavior. Methods: Techniques of spatial analysis, borrowed from the architectural theory of spatial syntax, were applied to the Time and Motion data set. Motion data from radio-frequency identification tracking of nurses was combined with architectural drawings of the study units and clinical information such as nurse-patient assignment. Spatial analytic techniques were used to determine the average integration or centrality of nurse assignments for each shift. Results: Nurse assignments with greater average centrality to all assigned rooms were associated with a higher number of entries to patient rooms, as well as to the nurse station. Number of entries to patient rooms was negatively correlated with average time per visit, but positively correlated with total time spent in patient rooms. The data describe two overall strategies of nurse mobility patterns: fewer, longer visits versus more frequent, shorter visits. Conclusions: Results suggest that the spatial qualities of nurse assignments and unit layout affect nurse strategies for moving through units and affect how frequently nurses enter patient rooms and the nurse station.
Exploring the Impact of the Physical Environment on Patient Outcomes in Ambulatory Care Settings
Authors: Gulwadi Gowri Betrabet , Joseph Anjali , Keller Amy Beth 
Published: February 2015

Objective: This report of empirical literature on ambulatory care centers (ACCs) addresses a gap in the healthcare field by exploring physical features of ACC settings that have been associated with favorable patient outcomes. Background: Growing numbers of ACCs correspond with an increasing shift from inpatient to outpatient services. As the focus of ACCs shifts from treating episodes of illnesses to comprehensive, longitudinal, patient-centered care, different types of ACC settings seek to accommodate a variety of patient groups from different demographics. Methods: Given the range of ACC settings and population types and the paucity of literature focused on any one of these settings, the literature search process was broad based to include not only peer-reviewed literature, but also “gray literature” on ACC design. The primary focus was on research studies and reports that centered on some aspect of the physical environment in ACCs and their relationship to outcomes in these settings. Results: The following patient outcomes were identified in different phases of ACC patient experience: improved access and wayfinding, enhanced waiting experience, enhanced privacy, enhanced physician/staff-patient communication, reduced patient anxiety, and reduced risk of infection. Conclusions: This article identifies physical design features of ACCs that can promote favorable patient outcomes. However, most literature reviewed adheres to a physician-centered model of episodic illness in which care ends with the experience in the exam room of the ACC. A more patient-centered approach has not been explored fully in the literature. The results indicate that there are many opportunities for future inquiry.
Using Task Analysis in Healthcare Design to Improve Clinical Efficiency
Authors: Lu Jun , Hignett Sue 
Published: February 2015

Objective: To review the functionality of the proposed soiled workroom design for efficient and safe clinical activities. Background: As part of a hospital refurbishment program, the planning team of a United Kingdom National Health Service hospital requested a review of a proposed standardized room design. Methods: A 7-day observational study was conducted in five clinical departments at three hospitals. Link analysis was used to record and analyze the movements among components, i.e., nursing staff, equipment/devices, and furniture. Results: Fifty-four observations were recorded for 18 clinical tasks. The most frequent tasks were the disposal of urine and used urine bottles, and returning used commode chairs. Minor recommendations were made to improve the proposed design, and major revisions were suggested to address functionality problems. Conclusion: It was found that the proposed design did not offer the optimal layout for efficient and safe clinical activities. Link analysis was found to be effective for plotting the movements of the staff and accounting for the complexity of tasks. This ergonomic method, in combination with observational field studies, provided a simple and effective way to determine functional space requirements for clinical activities and should be used in all healthcare building design projects.
Color Perception in Pediatric Patient Room Design: Healthy Children vs. Pediatric Patients
Authors: Park Jin Gyu 
Published: February 2015

Objective: The purpose of this study was to investigate the value of color as a component of a healing environment for pediatric patient rooms. Color preferences from pediatric inpatient, pediatric outpatient, and healthy children groups were investigated and compared for group and gender differences. Background: Positive environmental stimulation can promote patient well-being by reducing stress or negative feelings. If environmental colors can have positive influences, then those colors will make patients more comfortable, reducing their stress. Although previous color studies are suggestive, none has focused on pediatric healthcare environments. Patients' health status may affect their reaction to environmental stimulation. There was a gap in the body of knowledge regarding the consistency of color preferences with regard to patient health status. Methods: A simulation method was used because of its reliability and feasibility. It allowed for investigating the value of color in real contexts and controlling confounding variables. Previous color preference studies typically have been done with small colored squares of paper, which are visually different from seeing a color applied on wall surfaces. In addition, they failed to control confounding variables such as color attributes and light sources. Results: Group differences were not significant. This refuted the hypothesis that the color preferences of pediatric patients are different from those of healthy children. However, overall color preferences showed that the healthy children group had higher mean scores of color preferences than both pediatric outpatients and inpatients groups. Gender effects were identified across all three groups. Conclusions: All three groups showed similar color preference patterns, except for yellow. Both pediatric outpatients and inpatients preferred yellow less than healthy children did. Healthy children's mean scores of color preferences were higher than the pediatric outpatients; the pediatric outpatients group had higher mean scores of color preferences than the pediatric inpatients group. Although this observation was not statistically significant, it raised the question of whether the sickest pediatric patients respond differently to color than healthy children do. Gender effects indicated that girls preferred red and purple more than boys do. Regardless of gender effects, healthy children and pediatric patients preferred blue and green the most and white the least. These results can help healthcare providers and professionals better understand appropriate colors for pediatric populations.
Consultation Room Design and the Clinical Encounter: The Space and Interaction Randomized Trial
Authors: Almquist Julka R. , Kelly Caroline , Bromberg Joyce , Bryant Sandra C. , Christianson Teresa J. H. , Montori Victor M. 
Published: February 2015

Objective: The design of the consultation room remains largely unaltered despite major changes in clinical practice, such as the electronic medical record and patient-centered care. The value of redesigning the consultation room to accommodate these changes and the effect of a redesign on patient-clinician interaction are unclear. Methods: The authors randomly allocated 65 patient-physician dyads to consultations in a standard room ( n = 30) or in an experimental room designed with a semicircular table around which the clinician and the patient sat, with equal access to the computer screen ( n = 35). Participant responses to post-visit surveys, assessing patient experiences in these rooms, were compared in an intention-to-treat fashion. Results: The authors found no differences between the rooms in terms of patient satisfaction with the consultation, mutual respect, or communication quality. Compared to the standard room, patients in the experimental room were better able to interact with the computer monitor (24 [75%] vs. 17 [59%], P = 0.07) and had a greater ability to look at the screen at any time (22 [73%] vs. 8 [28%], P < 0.001); and they reported that clinicians allowed them to review the medical record on the screen (22 [71%] vs. 13 [45%], P = 0.012), shared information on the computer screen (24 [80%] vs. 18 [60%], P = 0.037), and reviewed information on the Internet with the patient (13 [43%] vs. 7 [26%], P = 0.010) more than those in the standard room. Conclusions: The design of the consultation room affects the clinical encounter. In particular, ready access to a computer screen using the electronic medical record and the Internet may enhance information sharing.
Adapting to Family-Centered Hospital Design: Changes in Providers' Attitudes over a Two-Year Period
Authors: France Daniel , Throop Patricia , Joers Barbara , Allen Lauran , Parekh Amruta , Rickard Dorsey , Deshpande Jayant K. 
Published: February 2015

Objective: The United States is currently in the midst of a hospital construction boom. An increasing number of hospitals are being designed using the principles of evidence-based design to improve patient safety and patient satisfaction. Few studies have examined the impact of new hospital design models on providers' attitudes or work performance. The goal of this study was to determine how providers' attitudes at one children's hospital changed over a 2-year period. It was hypothesized that clinicians' attitudes about their work environment would be significantly more positive 2 years after opening. Background: In 2004 a children's hospital within a hospital was replaced with a free-standing facility, which was designed on the theme of family-centered care. The hospital quality improvement team developed and administered the Environment of Work survey to measure providers' initial impressions of the hospital design on job function, patient safety, and personal well-being. The survey was readministered approximately 2 years later to measure changes in providers' perceptions about the same issues. Methods: A 25-item survey was administered to a convenience sample of clinical staff to measure their attitudes about the effects of family-centered hospital design on providers and patients. Chi-square tests were used to compare subjective ratings collected from the two surveys on pooled samples and on samples stratified by clinical unit. Results: Surveys were collected from 270 clinicians (a 25% response rate) in 2004 and 544 clinicians (a 51% response rate) in 2006. Nurses accounted for a higher percentage of total respondents (78% versus 57%). Most domain areas garnered improved and overall positive ratings from clinicians in 2006. Providers' ratings of elevated mental fatigue, physical fatigue, and walking burden remained high in 2006 despite improvements. Ratings of noise levels increased on all units except the neonatal intensive care unit. Fewer respondents rated the new hospital “somewhat to much better” than the former hospital. Conclusions: Moving into a new healthcare facility is a stressful event for healthcare providers and adapting to a new work environment requires a lengthy period of transition. Providers' initial ratings of a new workspace are likely to change over time as they adjust their work practices to the physical environment.
Operationalizing Lean Health Assets
Authors: Price Ilfryn , Pinder James , Wyton Paul G. 
Published: February 2015

Objective: To demonstrate the potential of employing unconventional facility/facilities management (FM) performance indicators in healthcare settings to enable more strategic conversations between FM and business users concerning asset performance. Background: The theoretical background for a Lean asset approach and a high-level analysis of data from hospital trusts in England have been published elsewhere. This paper reports on the first uses of that approach in operational settings. Method: Observations are drawn primarily from three case studies. Results: The individual studies support the premise that the conventional emphasis on cost per square meter (m2) as a preeminent measure of FM disguises a portfolio of too much underutilized space. They provide a means of putting a healthcare estates strategy in terms that will engage business users. Conclusions: Despite a growing interest in Lean approaches in healthcare, the philosophy has not yet been extended to the estate. This study demonstrates that alternative benchmarks are possible.
Measuring the Structure of Visual Fields in Nursing Units
Authors: Lu Yi 
Published: February 2015

Objective: The purpose of this study was to develop quantitative measures of the structure of visual fields in nursing units. Background: The structure of visual fields in nursing units—especially visibility toward patient beds—is believed to have a direct influence on the routine use of space by medical staff and patient outcomes within units. Although previous studies are suggestive, none has developed rigorous measures of the visibility within nursing units. Methods: To compare the degree of visibility toward patient beds among different nursing units, the targeted visibility index (TVI) was introduced. The TVI measures the degree to which an observer can see all targets in a nursing unit. It provided a comparative spatial quality evaluation of various nursing unit configurations with differing numbers of patient beds. It was developed and programmed on the ArcGIS version 9.2 platform (ESRI Inc., Redlands, CA) with component object model-based ArcObjects and Visual Basic for Application language (Microsoft). Results: The assessment of three nursing unit designs by TVI aligned exactly with empirical evaluations conducted in previous studies. Conclusions: This study provided an opportunity and supplied relevant measures for healthcare facility designers to specify the visual structures of important behavioral effects. It is anticipated that the TVI will contribute to the understanding of healthcare design and the resulting outcomes.