Articles and Publications

Rx: Window Bed

February 1, 2014 / Dochitect / Design for Geriatrics

Peer-Reviewed Publications

Publication: Journal of the American Geriatrics Society, Old Lives Tales
Publication Reference: 2014 Feb;62(2):378-9.
Authors: D. Kirk Hamilton, BArch, MSOD; Diana C. Anderson, MD, MArch

“Interns, any other ideas?” my attending asked the team as we made our daily rounds to the bedside of Ms. T, an octogenarian who had been in our ICU for just over a week. She suffered from dementia and had undergone a tracheotomy, thus limiting her ability to communicate with us. The concern of my attending that morning was due to her sustained tachycardia, the etiology of which we could not explain; she had not responded to our medical interventions.

I was only days into my internship; how could I have any medical suggestions to address this patient’s heart rate? “We could move her to another room with a window,” I said to the group instead, yielding several questionable looks. “There is evidence,” I added, as I knew physicians would consider an intervention seriously if it had been documented in prior studies.

Read the complete story of one patient’s physiologic response to an environmental intervention and the subsequent change in the clinical team’s approach to considering architectural design and the existing evidence (subscription required).

Peer-Reviewed Publications

New Medical Staffing Procedures Call For Design Solutions

October 11, 2013 / Dochitect / Design for Clinical Staff

Commentaries

Publication: Healthcare Design
Publication Date: October 11, 2013
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The hybrid medical professional—physician-writer, physician-researcher, physician-educator, and the physician-editor—is often mentioned in literature and popular press. As a self-labeled “dochitect,” I propose a new hybrid model, the physician-architect, with the intent of bridging the gap between architecture and medicine through the field of healthcare design.

An architect now working as a resident physician, I maintain two notebooks in my white coat pocket: one for medical facts, a common finding amongst trainees, and the other for design notes and sketches.

Click here to read about how the changing practices of medical training can impact staff space, and the subsequent needs for effective care delivery.

Commentaries

Using evidence based design to produce healthier hospital buildings

September 14, 2013 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: British Medical Journal (BMJ) Careers
Publication Date: September 14, 2013
Authors: D. Kirk Hamilton, BArch, MSOD; Diana C. Anderson, MD, MArch
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Excerpt: Evidence about how architecture affects staff and patients is increasingly influencing the hospital design. Diana Anderson, a qualified architect and hospital doctor and Kirk Hamilton, an architect now working in academia after 30 years of practice, provide an international perspective on the issues involved.

Diana Anderson describes the personal experiences of poor hospital design:

I am a resident physician, and a large part of my hesitation in pursuing advanced clinical training was because of what I considered an intolerable hospital setting. Staff facilities are frequently without windows or art, and I have found myself desperately anticipating the first ray of sunlight after a long shift. Working in environments with constant noise from ventilator and infusion alarms, floor polishers, telephones, pagers, and staff discussions creates an ongoing battle to work effectively, or to hold private, often life changing discussions with patients.

During my initial time working in hospitals I often wondered whether anyone asked the clinicians about their opinions on the design and function of their work environments, and whether it has been recognised that the characteristics of the physical environment can enhance or hinder productivity, and can reduce the stress associated with our work and the condition of our patients. On my obstetrics rotation as a medical student the call rooms were located several floors above the labour and delivery unit, meaning we often missed deliveries, and so we learnt not to use the suite, and we slept in chairs closer to our patients. On patient units that did not provide space for respite, I found myself retreating to the supply rooms to gain composure during overwhelming moments. As a physician, a licensed architect, and a patient, I believe that many planned spaces are ill suited to their actual use.

Click here to view the full article on evidence-based design and healthier hospital buildings.

Peer-Reviewed Publications

Guidelines for Intensive Care Unit Design

May 1, 2012 / Dochitect / Design for Critical Care

Peer-Reviewed Design Guidelines

Publication: Critical Care Medicine
Publication Reference: 2012 May;40(5):1586-600.
Authors: Dan R. Thompson, MD, MA, FACP, FCCM (Co-Chair); D. Kirk Hamilton, FAIA, FACHA (Co-Chair); Charles D. Cadenhead, FAIA, FACHA, FCCM; Sandra M. Swoboda, RN, MS, FCCM; Stephanie M. Schwindel, MArch, LEED; Diana C. Anderson, MD, MArch; et. al.
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Note This document was awarded the following: 2013 Society of Critical Care Medicine Section Award Winner for Published Guidelines.

Abstract

Objective: To develop a guideline to help guide healthcare professionals participate effectively in the design, construction, and occupancy of a new or renovated intensive care unit.

Participants: A group of multidisciplinary professionals, designers, and architects with expertise in critical care, under the direction of the American College of Critical Care Medicine, met over several years, reviewed the available literature, and collated their expert opinions on recommendations for the optimal designof an intensive care unit.

Scope: The design of a new or renovated intensive care unit is frequently a once- or twice-in-a-lifetime occurrence for most critical care professionals. Healthcare architects have experience in this process that most healthcare professionals do not. While there are regulatory documents, such as the Guidelines for the Design and Construction of Health Care Facilities, these represent minimal guidelines. The intent was to develop recommendations for a more optimal approach for a healing environment.

Data Sources and Synthesis: Relevant literature was accessed and reviewed, and expert opinion was sought from the committee members and outside experts. Evidence-based architecture is just in its beginning, which made the grading of literature difficult, and so it was not attempted. The previous designs of the winners of the American Institute of Architects, American Association of Critical Care Nurses, and Society of Critical Care Medicine Intensive Care Unit Design Award were used as a reference. Collaboratively and meeting repeatedly, both in person and by teleconference, the task force met to construct these recommendations.

Conclusions: Recommendations for the design of intensive care units, expanding on regulatory guidelines and providing the best possible healing environment, and an efficient and cost-effective workplace.

Key Words: architecture; construction; critical care medicine; design; environment; healing; intensive care unit

Click here to view the 2012 Guidelines for ICU Design.

Peer-Reviewed Design Guidelines

Bridging the Gap: Multidisciplinary Collaboration in Medicine and Architecture

May 1, 2011 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: University of Toronto Medical Journal
Publication Reference: 2011;88(3):129-134.
Authors: Elizabeth Viets-Schmitz, AIA; Diana Anderson, MD, MArch.
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2011_UTMJ COVER As the world becomes increasingly connected and information is freely shared, a trend toward interdisciplinary collaboration is taking place in both industry and education. This trend is highlighted by recent collaboration between clinicians and architects in both research and design. In the design of healthcare spaces, architects are working with clinicians and researchers to employ an evidence-based approach to making design decisions.

The advent of Evidence-Based Design represents a shift from basing design decisions solely on tradition or opinion to an approach that emphasizes the importance of using credible research to inform design decisions. The research expertise of clinicians is vital to the practice of Evidence-Based Design, which traces its origins to the well-established concepts of Evidence-Based Medicine. In the context of healthcare, Evidence-Based Design focuses on design interventions that help make hospitals safer and more comfortable for patients and staff, that promote healing, and that are fiscally sustainable.

Through case studies and other examples, this paper illustrates how the growing body of credible research regarding the impact of the built environment on people creates unique opportunities for architects and clinicians to work together toward a common goal of evidence-based practice.

Peer-Reviewed Publications

Designing for Multidisciplinary Rounding Practices in the Critical Care Setting

April 1, 2011 / Dochitect / Design for Clinical Staff, Design for Critical Care

Peer-Reviewed Publications

Publication: World Health Design
Publication Reference: 2011;4(2):80-85
Authors: Diana C. Anderson, MD, M.Arch, LEED AP, S. Rob Todd, MD, FACS
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2011_Cover Rounding is critical to developing integrated care plans, and there is a trend for moving daily rounds from the bedside to conference rooms. This study’s aim was to document staff preferences for the location of rounding practices, and to determine the effect of available space on those preferences.

Read the full study on critical care rounding practices here.

Additional Press:

Note This study, “Staff Preference for Multidisciplinary Rounding Practices in the Critical Care Setting,” was presented at the International Academy for Design & Health: Design & Health 7th World Congress & Exhibition in Boston, Massachusetts; July 8, 2011.

Note This study was presented as a poster presentation at the Society of Critical Care Medicine Annual Congress in Miami, Florida; January 9-13, 2010.

Conference Presentations, Peer-Reviewed Publications

Catalysts for Change

April 1, 2011 / Dochitect / Commentaries & Event Reviews

Commentaries

Publication: World Health Design
Publication Reference: 2011;4(2):14-15.
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Healthcare reform in the US is still in transition, with the end-goal being to provide the highest quality care at the lowest possible cost. Experts anticipate that increased access to care will inevitably lead to more demand being placed on facilities and the existing building infrastructure. Changing the way that care is delivered will no doubt have an impact on space needs, prompting the design of environments that are cost-effective, functional and flexible.

With major healthcare reform underway in all corners of the globe, what role should designers and architects play in rising to its challenges?

Read what three experts who take a personal view from their own territory have to say, including North America, Australia and the UK.

Commentaries

Humanizing the Hospital: Design Lessons from a Finnish Sanatorium

August 10, 2010 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: Canadian Medical Association Journal (CMAJ)
Publication Date: First published online Sept 21, 2009. In print August 10, 2010;182(11):E535-E537.
Author: Diana C. Anderson, MD, MArch
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As medicine has moved toward evidence-based practice, so too has hospital design, which is increasingly guided by research linking physical environments to health care outcomes through the process of evidence-based design. The Paimio Sanatorium, built in the early 1930s in the southwest portion of Finland and designed by the architect Alvar Aalto, demonstrates an appreciation for good design and the ambition to create healing environments that emulate nature.

Prior to the development of evidence-based design, Alvar Aalto created a healing environment addressing each patient’s psychological and social needs. Just as the starting point in the Paimio Sanatorium design was the individual whose privacy and comfort were of central importance, the current field of evidence-based hospital design emulates this focus of the physical setting as therapeutic.

Peer-Reviewed Publications

I’m Still Here: A breakthrough approach to understanding someone living with Alzheimer’s Disease

December 29, 2009 / Dochitect / Design for Geriatrics

Book Review

Publication: Health Environments Research & Design Journal
Publication Date: 2009;3(1):118-120.
Book Author: John Zeisel, Ph.D.
Book Review Author: Diana C. Anderson, MD, MArch
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The book I’m Still Here: A breakthrough approach to understanding someone living with Alzheimer’s Disease acknowledges a deeper understanding of this devastating condition, the strength of non-pharmacologic treatments and, most importantly, an offer of hope for continued loving relationships and quality of life.

Click here to read dochitect’s complete book review.

Link to Purchase Book:

I’m Still Here Book Review

Fellowship: Opportunity, Mentorship, and Legacy

November 23, 2009 / Dochitect / Commentaries & Event Reviews

Commentaries

Publication: Healthcare Design Magazine
Date: November 23, 2009
Authors: Diana Anderson, MD, LEED AP; Kelly Egdorf, LEED AP, Assoc. & Ashley Dias, LEED AP, EDAC
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Architectural fellowships are relatively new in the architectural education process and may offer budding professionals increased benefits and career-promoting opportunities aimed at enriching the ongoing personal and professional development process.

Click here to read more about architectural fellowships.

Commentaries

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