bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design of Admission Medication Reconciliation Technology: A Human Factors Approach to Requirements and Prototyping
Authors: Lesselroth Blake J. , Adams Kathleen , Tallett Stephanie , Wood Scott D. , Keeling Amy , Cheng Karen , Church Victoria L. , Felder Robert , Tran Hanna 
Published: February 2015

OBJECTIVE: Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design. BACKGROUND: Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission. METHODS: We completed an ethnography and time and motion analysis of pharmacists in order to illustrate the processes used to reconcile medications. We then used the requirements to design prototype multimedia software for collecting a bedside medication history. We observed how pharmacists incorporated the technology into their physical environment and documented usability issues. RESULTS: Admissions occurred in three phases: (1) list compilation, (2) order processing, and (3) team coordination. Current medication reconciliation processes at the hospital average 19 minutes to complete and do not include a bedside interview. Use of our technology during a bedside interview required an average of 29 minutes. The software represents a viable proof-of-concept to automate parts of history collection and enhance patient communication. However, we discovered several usability issues that require attention. CONCLUSIONS: We designed a patient-centered technology to enhance how clinicians collect a patient's medication history. By using multiple human factors methods, our research team identified system themes and design constraints that influence the quality of the medication reconciliation process and implementation effectiveness of new technology.
Clinician Perceptions of a Changing Hospital Environment
Authors: Maguire Denise J. , Burger Kristina J. , O'Donnell Patricia A. , Parnell Lisa 
Published: February 2015

OBJECTIVE: The purposes of this study were to describe how a move into a new hospital influenced the work environment, how long it takes clinicians to adjust to such a significant change, and how much a new hospital work environment helps the practice shift toward patient- and family-centered care (PFCC). BACKGROUND: Creating a healthy work environment to keep patients safe and staff engaged in the mission of the organization is perhaps one of the most important roles of hospital administrators and nursing leaders. METHODS: A descriptive and comparative design was used to investigate how clinicians perceive, evaluate, and adjust to a new hospital environment, and how much a healthy work environment helps the practice shift toward patient- and family-centered care. RESULTS: Perceived stress was significantly higher than baseline 15 months after the move into the new hospital ( p < 0.0000), and employees with 3 or more years of service had significantly higher stress than others ( p < 0.000). Nurses had the second lowest mean stress score ( x = 12.5). The PFCC score increased significantly ( p < 0.007). CONCLUSIONS: The single-patient room model increased the workload of many clinicians, and their stress increased after 15 months. There were additional burdens not measured that also may have added to the stress of the participants. The new hospital enabled a significant practice shift toward PFCC.
Role of a Service Corridor in ICU Noise Control, Staff Stress, and Staff Satisfaction: Environmental Research of an Academic Medical Center
Authors: Wang Zhe , Downs Betsy , Farell Ashley , Cook Kimberly , Hourihan Peter , McCreery Shimby 
Published: February 2015

OBJECTIVE: To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction. BACKGROUND: Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented. METHODS: A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic. RESULTS: Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU ( p < 0.01). Analyses of acoustical data confirmed that the new ICU was significantly quieter ( p < 0.02). Observations revealed how the service corridor impacted patient care services and traffic. CONCLUSIONS: The addition of a dedicated service corridor works in the new unit for improving noise control and staff stress and satisfaction.
Stressed Spaces: Mental Health and Architecture
Authors: Connellan Kathleen , Gaardboe Mads , Riggs Damien , Due Clemence , Reinschmidt Amanda , Mustillo Lauren 
Published: February 2015

OBJECTIVE: To present a comprehensive review of the research literature on the effects of the architectural designs of mental health facilities on the users. BACKGROUND: Using a team of cross-disciplinary researchers, this review builds upon previous reviews on general and geriatric healthcare design in order to focus on research undertaken for mental health care facility design. METHODS: Sources were gathered in 2010 and 2011. In 2010 a broad search was undertaken across health and architecture; in 2011, using keywords and 13 databases, researchers conducted a systematic search of peer reviewed literature addressing mental health care and architectural design published between 2005 to 2012, as well as a systematic search for academic theses for the period 2000 to 2012. Recurrent themes and subthemes were identified and numerical data that emerged from quantitative studies was tabulated. RESULTS: Key themes that emerged were nursing stations, light, therapeutic milieu, security, privacy, designing for the adolescent, forensic facilities, interior detail, patients' rooms, art, dementia, model of care, gardens, post-occupancy evaluation, and user engagement in design process. Of the 165 articles (including conference proceedings, books, and theses), 25 contained numerical data from empirical studies and 7 were review articles. CONCLUSIONS: Based on the review results, especially the growing evidence of the benefits of therapeutic design on patient and staff well-being and client length of stay, additional research questions are suggested concerning optimal design considerations, designs to be avoided, and the involvement of major stakeholders in the design process.
Project Coalitions in Healthcare Construction Projects and the Application of Real Options: An Exploratory Survey
Authors: Dortland Maartje van Reedt , Dewulf Geert , Voordijk Hans 
Published: February 2015

OBJECTIVE: Exploring the impact of the type of project coalition on types of flexibility by analyzing considered and exercised flexibilities in separated and integrated project coalitions in the design and construction phase and the operations and maintenance phase of a healthcare construction project. BACKGROUND: Flexibility in healthcare construction projects is increasingly needed in order to deal with growing uncertainties. Until now, little research has been carried out on how and to what extent flexibility is incorporated in different types of project coalitions chosen by healthcare organizations. METHODS: An exploratory survey was conducted among health organizations in both cure and care. Questions were asked on the position of the real estate department within the organization, the type of project coalitions chosen and the rationale behind this choice, and the extent to which flexibility in terms of a real option was considered and to what extent it had been exercised in a project coalition. RESULTS: Integrated project coalitions pay more attention to flexibility in advance in both the process and the product, but exercise them to a lesser extent than separated project coalitions. The economic feasibility of real options is higher in integrated project coalitions. CONCLUSIONS: The study shows that real options thinking is already incorporated in real estate management of healthcare organizations, although more flexibility is considered in advance of the project than is actually realized during and after construction.
Senior Living Environments: Evidence-Based Lighting Design Strategies
Authors: White Michael D. , Ancoli-Israel Sonia , Wilson Richard R. 
Published: February 2015

OBJECTIVE: To review from an architectural lighting perspective the effects of indoor lighting on the health and well-being of people in senior living environments. BACKGROUND: The role of circadian rhythms in people with chronic disorders continues to be a focus of laboratory research and clinical trials. Beneficial, evidence-based indoor lighting design strategies are being considered for senior living environments, particularly for residents who have limited access to natural bright light. METHODS: Articles published 2002–2012 reporting the results of prospective, randomized, controlled clinical trials (RCTs) were accessed using the U.S. National Library of Medicine PubMed site using the following search terms: “light, sleep, circadian, randomized, controlled, nursing home” and “light, sleep, circadian, randomized, controlled, elderly.” RESULTS: The search resulted in 48 citations, of which 18 meet our pre-search criteria. Data from these RCTs indicate options such as programmable, 24-hour lighting algorithms that may involve light intensity, lighting duration, spectra (wavelength) and lighting timing sequences CONCLUSIONS: Valid and actionable data are available about circadian rhythms, sleep, and human health and well-being that can inform the design of lighting for long-term care. Evidence-based architectural design of a 24-hour light/dark environment for residents may mitigate symptoms of circadian disruption; evidence-based management of darkness is as important as evidence-based management of light. Further research is needed into the long-term circadian health needs of night staff members in order to understand the effects of shift work while, at the same time providing the highest level of care.
Environmental Design in Acute Care Settings: A Case Study of a Neurological Rehabilitation Unit
Authors: McCunn Lindsay J. , Gifford Robert 
Published: February 2015

OBJECTIVE: The purpose of this case study was to examine environmental variables that lead to staff error in acute care settings: noise; lighting; ergonomics, furniture, and equipment; and patient room design and unit layout. BACKGROUND: Chaudhury, Mahmood, & Valente (2009) reviewed a number of design considerations related to reducing errors by nursing staff in acute care settings. The Neurological Rehabilitation Unit (NRU) at one hospital served to further examine the design recommendations outlined by Chaudhury et al. (2009). METHODS: Based on photographs, a site tour, interviews with the NRU manager and with the son of a patient of 5 months, comparisons were made between the NRU and the acute care setting design considerations reviewed by Chaudhury et al. (2009). RESULTS: The NRU appeared to comply with many recommendations: enforced noise reduction was facilitated through limiting both the number of patients per room and the number of patients admitted to the unit. Distinct rooms were used for various tasks that helped to contain activity-based noise. A combination of daylighting and artificial lighting was in place, but efforts to control glare and thermal comfort were not integrated into the design. The ergonomic needs of employees were incorporated in the design of the NRU, and the layouts of patient rooms and the layout of the NRU in general also were compatible with the design recommendations reviewed by Chaudhury et al. (2009). CONCLUSIONS: Many of the design attributes advocated by Chaudhury et al. (2009) were included in the NRU. Supplemental research should be undertaken, however, to objectively measure nursing error, efficiency and staff satisfaction with respect to the comparisons and assumptions presented in this study.
Risk Assessment as Standard Work in Design
Authors: Morrill Patricia W. 
Published: February 2015

OBJECTIVE: This case study article examines a formal risk assessment as part of the decision making process for design solutions in high risk areas. The overview of the Failure Modes and Effects Analysis (FMEA) tool with examples of its application in hospital building projects will demonstrate the benefit of those structured conversations. BACKGROUND: This article illustrates how two hospitals used FMEA when integrating operational processes with building projects: (1) adjacency decision for Intensive Care Unit (ICU); and (2) distance concern for handling of specimens from Surgery to Lab. METHODS: Both case studies involved interviews that exposed facility solution concerns. Just-in-time studies using the FMEA followed the same risk assessment process with the same workshop facilitator involving structured conversations in analyzing risks. RESULTS: In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps. While the focus of this article is not the actual design solution, it is apparent that the risk assessment brought clarity to the situations resulting in prompt decision making about facility solutions. CONCLUSIONS: Hospitals are inherently risky environments; therefore, use of the formal risk assessment process, FMEA, is an opportunity for design professionals to apply more rigor to design decision making when facility solutions impact operations in high risk areas.
The Role of Water in the Transmission of Healthcare-Associated Infections: Opportunities for Intervention through the Environment
Authors: Denham Megan E. , Kasali Altug , Steinberg James P. , Cowan David Z. , Zimring Craig , Jacob Jesse T. 
Published: February 2015

OBJECTIVE: To assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in water that cause healthcare-associated infections (HAIs). BACKGROUND: Water can serve as a reservoir or source for pathogens, which can lead to the transmission of healthcare-associated infections (HAIs). Water systems harboring pathogens, such as Legionella and Pseudomonas spp., can also foster the growth of persistent biofilms, presenting a great health risk. TOPICAL HEADINGS: Strategies for interrupting the chain of transmission through the built environment can be proactive or reactive, and include three primary approaches: safe plumbing practices (maintaining optimal water temperature and pressure; eliminating dead ends), decontamination of water sources (inactivating or killing pathogens to prevent contamination), and selecting appropriate design elements (fixtures and materials that minimize the potential for contamination). CONCLUSIONS: Current evidence clearly identifying the environment's role in the chain of infection is limited by the variance in surveillance strategies and in the methods used to assess impact of these strategies. In order to optimize the built environment to serve as a tool for mitigating infection risk from waterborne pathogens—from selecting appropriate water features to maintaining the water system—multidisciplinary collaboration and planning is essential.
The Role of Facility Design in Preventing Healthcare-Associated Infection: Interventions, Conclusions, and Research Needs
Authors: Zimring Craig , Denham Megan E. , Jacob Jesse T. , Kamerow Douglas B. , Lenfestey Nancy , Hall Kendall K. , Kasali Altug , Cowan David Z. , Steinberg James P. 
Published: February 2015

OBJECTIVE: To summarize the findings and provide recommendations based on the multidisciplinary literature review and industry scan, focusing on the links between the built environment and healthcare-associated infections. To propose a research agenda in order to increase informed design decisions and advance the evidence base. BACKGROUND: The HAI-Design project explores the research linking a range of design interventions to healthcare-associated infection. The multidisciplinary team evaluated over 3,800 articles and conducted interviews with a range of stakeholders including CEOs, architects, designers, physicians and other healthcare experts, the results of which are featured in this special Supplement as topical papers. TOPICAL HEADINGS: The four topical papers describing the role of the built environment in the acquisition of healthcare-associated infections are summarized. The evidence evaluating the strategies for intervention through the built environment is analyzed, and a research agenda is proposed. CONCLUSIONS: While the evidence base supporting the efficacy of strategies and technologies continues to grow, there are currently few data that demonstrate a reduction in infection rates. The need for multidisciplinary collaboration and increased efforts to standardize the evaluation of environmental studies are essential to overcome the many challenges and improve the reliability of data
Challenging Research: Completing Participatory Social Research with Children and Adolescents in a Hospital Setting
Authors: Bishop Katherine 
Published: February 2015

OBJECTIVE: A discussion of the challenges to completing participatory social research with children and adolescents in a hospital setting. BACKGROUND: Beginning with the dominant medical culture of hospitals, coupled with a persistent skepticism of social and in particular qualitative research and its contribution to knowledge in medical circles, restrictive contextual challenges also include attitudinal, methodological, and logistical considerations. Together, these challenges hamper good participatory research practice and the capacity to maintain quality data, as well as impede children's participation in research, which has the capacity to contribute to healthcare design, policy, and planning processes. METHODS: Two studies in pediatric settings in Australia, one of which was completed in 2008 and the other which was discontinued in 2011, provide the basis for this research discussion. The discussion addresses the issues that persist in inhibiting the completion of participatory social research and the resulting impacts on research, children's right to participate, and the volume of evidence that is ultimately available from children's perspectives to support and inform healthcare design, planning, and policy in pediatric settings. CONCLUSIONS: Recommendations for changes that could strengthen and improve this research experience include building awareness of the potential value of this research; increasing its influence; building the capacity and knowledge of gatekeepers, ethics committees, and researchers working in this context; and recognizing and valuing children's competence and participation.
Patient Visibility and ICU Mortality: A Conceptual Replication
Authors: Lu Yi , Ossmann Michelle M. , Leaf David E. , Factor Philip H. 
Published: February 2015

OBJECTIVE: This study reanalyzes the data from a study by Leaf, Homel, and Factor (2010) titled “Relationship between ICU Design and Mortality” by adopting and developing objective visibility measures. BACKGROUND: Various studies attribute healthcare outcomes (patient falls, satisfaction) to a vague notion of patient room visibility. The study by Leaf and colleagues was the first to draw an independent association between patient mortality and patient room visibility, however “visibility” remains imprecise. METHODS: The original patient dataset was obtained from Dr. Leaf. The 664 patient sample assigned across 12 rooms at the medical ICU at Columbia University Medical Center was reanalyzed in terms of targeted visibility; the unit of analysis was the room, n = 12. Several computer-based visibility measures of patient rooms were used: patient head visibility, patient room visibility, and field of view to nursing station. Patient head visibility was defined as the percentage of area within the central nursing station from which the patient head could be seen; patient room visibility was defined as the percentage of area within the central nursing station that could see the patient room (average value of all patient room grids); field of view was defined as the maximum viewing angle from the patient head to the central nursing station. RESULTS: Among the sickest patients (those with Acute Physiology and Chronic Health Evaluation II > 30), field of view accounted for 33.5% of the variance in ICU mortality, p = 0.049 CONCLUSIONS: Subtle differences in patient room visibility may have important effects on clinical outcomes.
Examination of How and Why Over-the-Bed Tables Are Used: Use Cases and Needs from Healthcare Providers
Authors: Manganelli Joe , Threatt Anthony , Brooks Johnell O. , Healy Stan , Merino Jessica , Yanik Paul , Walker Ian , Green Keith 
Published: February 2015

OBJECTIVE: This article presents the results of an exploratory study in which 14 clinical and staff subject matter experts (SMEs) at a regional rehabilitation hospital were interviewed in order to understand how and why over-the-bed tables are used. BACKGROUND: It is important to understand how and why a device or environment is used when designing it, and not just what features and functions are preferred. This knowledge is valuable both for contextualizing user feature and function preferences and for characterizing and prioritizing design challenges and opportunities. METHODS: Fourteen hospital clinical and support staff subject-matter experts participated in semi-structured interviews with scenario enactments in a medium-fidelity, full-scale mock-up of a typical patient room. During these interviews, they interacted with two personas played by actors and were asked to enact an example of a normal visit, from entering the room through treatment/service and then exiting. Data were analyzed via methodological triangulation including frequency analysis, content analysis, and affinity diagramming. RESULTS: The results include a use-case analysis with illustrative sketches, a list of needs statements, and final observations. CONCLUSIONS: Successfully using the over-the-bed table is dependent upon proper positioning, especially in bed during meals. There are fewer problems associated with over-the-bed table use while seated in a chair than when in the bed. The over-the-bed table is a key component in acute care, inpatient therapies. Clinicians are generally open to “smart” furniture in the patient room but question its cost-effectiveness, robustness, and flexibility.