bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Positive Distractions on Children in Two Clinic Waiting Areas
Authors: Pati Debajyoti , Nanda Upali 
Published: February 2015

Objective: To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas. Background: People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment? Method: Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009. Results: Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.
Flexibility: Beyond the Buzzword—Practical Findings from a Systematic Literature Beview
Authors: Carthey Jane , Chow Vivien , Jung Yong-Moon , Mills Susan 
Published: February 2015

Objective: The goal was to identify practical, cost-effective, design-related strategies for “future-proofing” the buildings of a major Australian health department. Background: Many health buildings become obsolete before the end of their effective physical lives, requiring extensive reconfiguration or replacement. This study sought to move beyond the oft-used buzzword flexibility to seek effective strategies to accommodate future change (future-proofing) that could be further explored in Australia and other developed countries. Methods: A systematic literature review compiled definitions of flexibility and adaptability from a range of sources. Nineteen case studies were identified that illustrated various future-proofing strategies. A matrix was developed to classify different approaches to flexibility and then used to assess the case studies. Results: Analysis was hampered by inconsistent use of terminology and limited availability of quantifiable methods for assessing the long-term success of approaches to future-proofing. Several key strategies were identified, classified, and discussed in terms of their relevance and application. Conclusions: More rigorous definitions of flexibility, adaptability, and related terms are needed to enable more useful comparisons of the strategies implemented to future-proof health projects. Local conditions often affect both the strategies adopted and the degree to which they can be considered successful. Many of the case studies analyzed in this research were not operational long enough to enable assessment of their claims of being future-proofed. Therefore, review of lifetime facility costs, including the service life periods of major facility components, should be considered, and some older projects should be evaluated in terms of these criteria.
Integrated Healthscape Strategies: An Ecological Approach to Evidence-Based Design
Authors: Becker Franklin , Bonaiuto Marino , Bilotta Elena , Bonnes Mirilia 
Published: February 2015

Aim: This paper explores some of the premises of evidence-based design (EBD) and suggests that greater attention to and differentiation of the various purposes of research are needed, along with the development of an ecological theory that reflects the complexity of the health systems studied and more varied ways to communicate with and engage practitioners. Background: Problems with the American healthcare system are well known. For the past 20 years, an intervention that has gained increasing attention has been the physical design of healthcare facilities—hospitals in particular. EBD has been advocated as one means of using research to examine the relationship between design and healthcare to improve patient safety and the quality of care. Conclusions: The concept of integrated healthscape strategies is proposed to focus not only on research “evidence” and the methods used to collect and analyze it, but also on the different purposes research serves, the role of theory, and the use of EBD research in practice.
An Evaluation of Operating Room Safety and Efficiency: Pilot Utilization of a Structured Focus Group Format and Three-Dimensional Video Mock-Up to Inform Design Decision Making
Authors: Watkins Nicholas , Kobelja Mark , Peavey Erin , Thomas Stephen , Lyon John 
Published: February 2015

Objective: The purpose of this investigation was to identify safety and efficiency-related design features for inclusion in operating room (OR) construction documents. Background: Organizations are confronted with an array of challenges when planning an OR, including inefficiencies in operations, adverse events, and a variety of innovations to choose from. Currently, techniques that can be used in design practice and to inform design decision making for implementable OR solutions are limited. Methods: The project team used a structured focus group format with mixed methods to solicit 19 varying surgical team members' reactions to a three-dimensional video mock-up of a proposed OR. Data from the 19 participants were analyzed using stepwise multiple regression and content analysis of open-ended responses. Results and Discussion: Results demonstrate that several features of the proposed OR design predict meaningful outcomes, including flexibility and satisfaction with the OR setup, adverse event prevention, team performance, and distractions and interruptions. Participants' suggested solutions include universal booms to support anesthetic and perfusion capabilities, a fixed circulating nursing workstation that faces the patient and is at the foot of the operating room table, a wall-mounted monitor across from the surgeon, and wiring to support a touch-screen control arm in OR surgical fields. Conclusions: Findings from structured focus groups with mixed methods lead to implementable design solutions for construction documentation. The expeditious qualities and objectivity of the format are value-adds to the design decision-making process. Future research should use various techniques such as virtual technologies and building information modeling.
The Impact of Bedside Technology on Patients' Well-Being
Authors: Tanja-Dijkstra Karin 
Published: February 2015

Objective: This paper presents a study to gain insight into the effects of the visibility of medical equipment on the well-being of patients. Background: Encounters with healthcare situations are characterized by stress and anxiety. The presence of wires, tubes, and monitors near the bedside may contribute to these feelings. One of the trends in healthcare design is to organize the headwalls of patient rooms in such a way as to reduce clutter and minimize the visibility of medical equipment, but no experimental studies are available that investigate the effects of the visibility of medical equipment in patient rooms. Methods: This experiment employed a single-factor between-subjects design (medical equipment visible vs. medical equipment out of sight) exposing participants ( n = 42) to a scenario and a picture of a hospital room. Results: Placing medical equipment out of sight leads to reduced feelings of stress in patients. This stress-reducing effect is mediated by feelings of pleasure. Placing medical equipment out of sight leads to a more positive emotional state, which in turn leads to feelings of reduced stress in patients. Moreover, placing equipment out of sight leads to people having more trust in the healthcare provider. Conclusions: The current study emphasizes the importance of the built healthcare environment and shows what role the visibility of medical equipment can play in the healing process of patients.
Comparison of Private Room with Multiple-Bed Ward Neonatal Intensive Care Unit Environments
Authors: Van Enk Richard A. , Steinberg Florence 
Published: February 2015

Objective: This study determined whether a private room or open ward design better met optimal environmental conditions for a neonatal intensive care unit with regard to sound level, light level, temperature and humidity. Background: Multiple-bed designs for hospital neonatal intensive care units were the standard until recently. Now, private room designs promise to provide better conditions for neonate development and patient care quality. Methods: The study compared an eight-bed open ward design with a private room design of a 45-bed neonatal intensive care unit, measuring the environmental parameters of sound, light, temperature, and humidity before and after the construction and occupation of a new private room unit. Results: Average light levels were higher in the private room design because of the increased number of windows, but both designs were within the recommended levels. Mean temperature readings were two degrees cooler in the private room environment, and readings were more stable. Mean humidity readings in the two environments were the same, but humidity levels in the private room design were more stable. Median sound level in the private room design was lower than the open ward design, but the range was similar. Conclusion: The private room design allows for a more controlled patient care environment that can be maintained within a smaller range of variation nearer optimal environmental conditions.
Control and Mitigation of Healthcare-Acquired Infections: Designing Clinical Trials to Evaluate New Materials and Technologies
Authors: Sharpe Peter A. , Schmidt Michael G. 
Published: February 2015

Hospitals clean environmental surfaces to lower microbial contamination and reduce the likelihood of transmitting infections. Despite current cleaning and hand hygiene protocols, hospital-acquired infections (HAIs) continue to result in a significant loss of life and cost the U.S. healthcare system an estimated $45 billion annually. Stainless steel and chrome are often selected for hospital touch surfaces for their “clean appearance,” comparatively smooth finish, resistance to standard cleaners, and relative effectiveness for removing visible dirt during normal cleaning. Designers use wood surfaces for aesthetics; plastic surfaces have become increasingly endemic for their relative lower initial cost; and “antimicrobial agents” are being incorporated into a variety of surface finishes. This paper concentrates on environmental surface materials with a history of bactericidal control of infectious agents and focuses on the methods necessary to validate their effectiveness in healthcare situations. Research shows copper-based metals to have innate abilities to kill bacteria in laboratory settings, but their effectiveness in patient care environments has not been adequately investigated. This article presents a research methodology to expand the evidence base from the laboratory to the built environment. For such research to have a meaningful impact on the design/specifying community, it should assess typical levels of environmental pathogens (i.e., surface “cleanliness”) as measured by microbial burden (MB); evaluate the extent to which an intervention with copper-based materials in a randomized clinical trial affects the level of contamination; and correlate how the levels of MB affect the incidence of infections acquired during hospital stays.
The Impact of Daylight and Views on ICU Patients and Staff
Authors: Shepley Mardelle McCuskey , Gerbi Raymond Peter , Watson Angela E. , Imgrund Stephen , Sagha-Zadeh Rana 
Published: February 2015

Objective: Using a pre-test/post-test quasi-experimental study in two New Hampshire ICUs, the impact of daylight and window views on patient pain levels, length of stay, staff errors, absenteeism, and vacancy rates were examined. One ICU was operational until 2007, the second opened in 2007. ICU patients were randomly selected from cardiac surgery, pneumonia, and chronic obstructive pulmonary disease admissions of one or more days, 58 from the old ICU, and 52 from the new. Regular medical staff members assigned to the unit between October 2006 and September 2007 (old unit) and March 2008 and February 2009 (new unit) were included. Results: Variables other than unit design had a more significant impact on relative pain levels in each unit. Comparing light levels independent of ICU assignment supported the hypothesis that increased light levels reduce pain perception and length of stay, but the relationship was not statistically significant. One trend, not statistically significant, suggested that view was associated with reduced pain perception. A decrease in incident filings supported the hypothesis that improved natural light and views reduced errors, but results were not statistically significant. Some subcategories demonstrated significance. Mean absenteeism per person decreased from 38 to 23 hours from the old unit to the new (p = 0.05). Average vacancy rates decreased by 25% (from 10.12% to 7.49% staff openings per year) in the old and new units (p = 0.04). Conclusion: High levels of natural light and window views may positively affect staff absenteeism and staff vacancy. Factors such as medical errors, patient pain, and length of stay require additional research.
Wall Finish Selection in Hospital Design: A Survey of Facility Managers
Authors: Lavy Sarel , Dixit Manish K. 
Published: February 2015

Objective: This paper seeks to analyze healthcare facility managers' perceptions regarding the materials used for interior wall finishes and the criteria used to select them. It also examines differences in wall finish materials and the selection process in three major hospital spaces: emergency, surgery, and in-patient units. These findings are compared with healthcare designers' perceptions on similar issues, as currently documented in the literature. Background: Hospital design and the materials used for hospital construction have a considerable effect on the environment and health of patients. A 2002 survey revealed which characteristics healthcare facility designers consider when selecting materials for healthcare facilities; however, no similar study has examined the views of facility managers on building finish selection. Methods: A 22-question survey questionnaire was distributed to 210 facility managers of metropolitan, for-profit hospitals in Texas; IRB approval was obtained. Respondents were asked to rank 10 interior wall finish materials and 11 selection criteria for wall finishes. Data from 48 complete questionnaires were analyzed using descriptive statistics and nonparametric statistical analysis methods. Results: The study found no statistically significant differences in terms of wall finish materials or the characteristics for material selection in the three major spaces studied. It identified facility managers' four most-preferred wall finish materials and the five-most preferred characteristics, with a statistical confidence level of greater than 95%. Conclusions: The paper underscores the importance of incorporating all perspectives: facility designers and facility managers should work together toward achieving common organizational goals.
Using Data to Drive Emergency Department Design: A Metasynthesis
Authors: Welch Shari J. 
Published: February 2015

Objective: There has been an uptick in the field of emergency department (ED) operations research and data gathering, both published and unpublished. This new information has implications for ED design. The specialty suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations. Methods: The following sources were used to capture and summarize the research and data collections available regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both PubMed and Google Scholar search engines; and data presented at conferences and proceedings. Results: Critical information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands and contracts in response to changing census. Operational improvements have been clearly identified and are grouped into three categories: input, throughput, and outflow. Applications of this information are suggested. Conclusion: The sentinel premise of this meta-synthesis is that data derived from improvement work in the area of ED operations has applications for ED design. EDs can optimize their functioning by marrying good processes and operations to good design. This review paper is an attempt to bring this new information to the attention of the multidisciplinary team of architects, designers, and clinicians.
Innovation Pilot Study: Acute Care for Elderly (ACE) Unit—Promoting Patient-Centric Care
Authors: Krall Eva , Close Jacqueline , Parker Joseph , Sudak Maria , Lampert Susan , Colonnelli Kim 
Published: February 2015

Purpose: Older patients, defined as age 65 years or older, comprise more than 40% of admissions to the acute care environment. These patients' needs are different; cognitive impairment, chronic health issues, caregiver burden, and maintenance of functional level present challenges to healthcare organizations when caring for this population on a general medical-surgical unit. Background: A pilot project, the creation of a six-bed Acute Care for Elderly (ACE) unit situated within a 33-bed medical-surgical unit, was established to meet the unique needs of this older patient population. Conclusions: Outcomes including falls, pressure ulcers, functional level (the latter as measured by the KATZ), and length of stay were examined and demonstrated marked improvement compared to similar patients outside the ACE unit. Older patients need individualized care planning by staff competent in elder care and a specialty unit to address their specific needs
Making Acuity-Adaptable Units Work: Lessons from the Field
Authors: Zimring Craig , Seo Hyun-Bo 
Published: February 2015

Objective: Because there have been no clear directions on how to implement acuity-adaptable units (AAUs), this paper describes actual tactics and strategies that have worked in multiple institutions. Background: AAUs have been used in hospitals for the past decade, but reports in the literature have indicated both successes and difficulties in meeting operational goals and objectives. Despite various views regarding acuity adaptability, there is little in the literature that suggests why it works in some hospitals and not in others. Method: As part of a larger construction project, this project team interviewed the leaders of six hospitals to determine what was associated with the successful implementation of AAUs. Results: This paper reports on themes that emerged from these interviews, namely: choose the right specialty for medical centers; adopt the AAU model for the entire facility in community hospitals; bring in and train the right people; change culture through communication; and use acuity-adaptable unit clusters. Discussion and Conclusions: Main themes, predictable patient progress, and culture change are further discussed and key recommendations are described.
A Comprehensive Comparison of Open-Bay and Single-Family-Room Neonatal Intensive Care Units at Sanford Children's Hospital
Authors: Stevens Dennis C. , Helseth Carol C. , Thompson Paul A. , Pottala James V. , Khan M. Akram , Munson David P. 
Published: February 2015

Objective: This paper summarizes the results of a comprehensive comparison of open-bay (OPBY) and single-family-room (SFR) neonatal intensive care unit (NICU) designs. Background: The NICU expanded from 7000 ft2 in two large rooms to 27,000 ft2 with 45 individual family spaces. Results: Sound measurements indicated a significant reduction in the unoccupied SFR to less than half of the levels in the OPBY NICU. However, respiratory support equipment generated levels well above those of the ambient environment. Illumination was significantly reduced in the SFR. Ambient illumination in nursing work areas was less than recommended. In other comparisons with the OPBY NICU the SFR NICU was shown to have: a shorter interval until full enteric feedings were established; improved parent satisfaction; improved staff perceptions of the environment and care; a decrease in nurses State-Trait Anxiety scores; an increased need for total numbers of staff and nursing staff per shift; increased walking per shift by nurses and nurse practitioners; and improved sleep time in a very small sample of patients. Analysis of the cost of construction showed comparable cost per ft2; however, the cost per bed in the SFR NICU was much greater because of the increased area of this facility. Highly notable findings of this investigation included the same incidence of adverse outcomes of care and a reduction in the adjusted direct cost of care in the SFR NICU. Conclusion: These data overwhelmingly support the SFR NICU in preference to the traditional OPBY facility. They substantiate that the SFR NICU should be the new standard for NICU care.
Image and Emotion: From Outcomes to Brain Behavior
Authors: Nanda Upali , Zhu Xi , Jansen Ben H. 
Published: February 2015

Aim: A systematic review of neuroscience articles on the emotional states of fear, anxiety, and pain to understand how emotional response is linked to the visual characteristics of an image at the level of brain behavior. Background: A number of outcome studies link exposure to visual images (with nature content) to improvements in stress, anxiety, and pain perception. However, an understanding of the underlying perceptual mechanisms has been lacking. In this article, neuroscience studies that use visual images to induce fear, anxiety, or pain are reviewed to gain an understanding of how the brain processes visual images in this context and to explore whether this processing can be linked to specific visual characteristics. Conclusions: The amygdala was identified as one of the key regions of the brain involved in the processing of fear, anxiety, and pain (induced by visual images). Other key areas included the thalamus, insula, and hippocampus. Characteristics of visual images such as the emotional dimension (valence/arousal), subject matter (familiarity, ambiguity, novelty, realism, and facial expressions), and form (sharp and curved contours) were identified as key factors influencing emotional processing. The broad structural properties of an image and overall content were found to have a more pivotal role in the emotional response than the specific details of an image. Insights on specific visual properties were translated to recommendations for what should be incorporated—and avoided—in healthcare environments.