Publication type: "Peer-Reviewed Publications"

Built Environment Design Interventions at the Exits of Secured Dementia Care Units: A Review of the Empirical Literature

October 9, 2022 / Dochitect / Design for Geriatrics, Evidence-Based Design

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2022 Oct 9;19375867221125930. doi: 10.1177/19375867221125930.
Authors: Anderson DC, Kota SS, Yeh L, & Budson AE
Date: October 9, 2022. Online ahead of print.

Abstract

Purpose: To review evidence around design interventions that influence exiting attempts in dementia care units, informing architectural and clinical practice.

Background: Built environment design is recognized as important in the care and management of responsive behaviors for those living with Alzheimer’s disease and other dementias in secured dementia care units (e.g., exiting attempts, agitation). The repetitious behavior of “walking with purpose” (previously termed wandering) in those with dementia has influenced safety-related architectural design components of dementia care units that decrease exiting attempts. Empirical literature addressing design interventions to prevent exiting for those with dementia is lacking and outdated.

Methods: We sought to describe known design techniques through a topical analysis of experimental studies. A thorough search for empirical studies that assessed interior design interventions at exit doors within dementia care units was undertaken. The review included an extensive search for existing literature and a screening of each study identified for its relevance, quality, and applicability.

Results: The experimental studies included in the review collectively assessed five interior design interventions at egress doorways: implementing horizontal and vertical floor grid patterns, mirrors, murals, conditioning responses to color cues, and camouflaging door hardware or vision panels. Why empirical studies have not continued more recently as built environment trends have shifted toward promoting meaningful and purposeful movement through design are considered. Advances in our understanding around the pathophysiology of dementia which might affect future design interventions related to egress are also identified.

Conclusion: The built environment is an important part of dementia care, and further prospective research is needed on the role of design interventions in the context of exiting attempts within secured units and subsequent behavior outcomes.

Keywords: Alzheimer’s disease; Built environment design; architecture; dementia; long-term care; nursing home; visual barriers; wandering.

Find the full article HERE.

Peer-Reviewed Publications

HERD Editorial: Evidence, Bioethics, and Design for Health

May 5, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: Health Environments Research and Design
Publication Reference: 2022, Vol. 15(2) 13-21
Author: Hamilton, DK

Editorial Excerpt

I like to tell my students that if there is compelling evidence that if design can improve clinical outcomes and patient safety, then healthcare architects have a moral and ethical responsibility to utilize such evidence. This is only a small step beyond every licensed architect’s obligation to protect the health, safety, and welfare of the public. Similarly, I propose that if credible evidence links design and outcomes, institutional boards and their executives have a moral obligation to engage architects, engineers, designers, and consultants who can and will effectively use such evidence

My colleague, Ray Pentecost, recently told me of a set of conversations he was having with friends about bioethics and responsibility as related to design evidence. It is a self-initiated, multidiscipline, and regionally distributed group including architects, physicians, and ethicists. The group’s overall focus adds a bioethics lens to the application of evidence in the health design field. They have been working for more than 2 years at the intersection of healthcare design and bioethics in order that healthcare environments and the way they are experienced can be markedly improved. The group perceives that despite well-intentioned healthcare administrators, architects, physicians, and others, the idea of connecting a strong, common ethos to a data-driven framework and research informed design for health has been slow to develop in comparison to other professions. Their ideas have slowly grown based on dialogue, publications, and presentations.

Pentecost (2022a) has produced an HERD guest editorial about the Union Internationale des Architectes Public Health Group (UIA/PHG) declaration of 2022 as the Year of Design for Health in our last issue. The group has an article published in Health Facilities Management (Hercules et al., 2022) and a piece in the Hastings Center Review (Anderson et al., 2022) and blog (Anderson et al., 2021). Hearing of their conversations led me to want to hear more. We arranged for some conversations on Zoom to further explore their ideas.

Figure 1. January 9, 2022, L to R, top to bottom; Hercules, Hamilton, Deemer, Pentecost, Anderson, Guenther, and Teti.

Read the full editorial HERE.

Peer-Reviewed Publications

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

May 1, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The Hastings Center Report
Publication Reference: March-April 2022, https://doi.org/10.1002/hast.1353
Authors: Diana C. Anderson, Stowe Locke Teti, William J. Hercules, David A. Deemer

Abstract

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long-term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

JHD Editorial – Widening the lens: Clinical perspectives on design thinking for public health

November 25, 2020 / Dochitect / Design for Clinical Staff, Design for Patient Safety, Design for Resiliency

Peer-reviewed publication

Publication: The Journal of Health Design
Publication Reference: Vol 5, No 3 (2020): The Year Like No Other
Authors: Bassin BS, Nagappan B, Sozener CB, Kota SS, Anderson DC

Abstract
The COVID-19 pandemic has created opportunities for innovation, ingenuity, and system reengineering. The next big investment in health care should be intentional and embedded partnerships between clinicians, designers, and architects who can collaborate to help solve health care’s greatest challenges.

“We think it is time to support a paradigm change and advocate for healthcare’s next big investment: intentional and embedded partnerships between clinicians, designers, and architects with dedicated resources to ensure an effective collaborative environment to help solve healthcare’s greatest challenges.”

Read the full editorial HERE.

Listen to the podcast with the authors HERE.

Peer-Reviewed Publications

Nursing Home Design and COVID-19: Balancing Infection Control,Quality of Life, and Resilience

October 31, 2020 / Dochitect / Design for Geriatrics, Design for Infection Control, Design for Resiliency

Peer-reviewed publication

Publication: JAMDA – The Journal of Post-Acute and Long Term Care Medicine
Publication Reference: COVID-19 Special Article| Volume 21, ISSUE 11, P1519-1524, November 01, 2020
Authors: Anderson DC, Grey T, Kennelly S, O’Neill D

Abstract
Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

Access the full article HERE.

Peer-Reviewed Publications

Getting Neighborly in 2030: A Shared Fellow Workspace Improves Communication, Teaching, and Burnout

June 21, 2020 / Dochitect / Design for Clinical Staff

Peer-reviewed publication

Publication: Journal of Graduate Medical Education
Publication Reference: June 2020, Vol. 12, No. 3, pp. 358-360.
Authors: Block Bl, Anderson D, O’Brien B, Babik J

Excerpt:

Over the past several decades, hospitalized patients have become increasingly complex, often with multisystem needs. In response, hospital teams now rely heavily on subspecialty consultants and interprofessional colleagues. While this has improved care delivery, fragmentation of responsibilities has changed the clinical learning environment, and graduate medical education has suffered.

By the mid-2020s, collaborative models of care made it unclear who was responsible for teaching and evaluating residents. Subspecialty consultation—particularly e-consults—were common, but residents and fellows rarely met face-to-face, forfeiting opportunities for workplace learning. Isolation and anonymity overtook any sense of community in the hospital, and rates of burnout soared. Moreover, asynchronous siloed work patterns led to misunderstandings and conflicting recommendations from different teams.

Recognizing the potential for the built environment to impact work patterns and workplace learning, we assessed whether colocating medicine subspecialty fellows in a shared workspace near the medicine resident workroom could increase face-to-face interactions during subspecialty consultation. We hypothesized this would have benefits for communication, teaching, and burnout.

Figure: Schematic of Old and New Hospital Buildings on Campus

Note: Panel A depicts the original distribution of fellow workspaces across 3 buildings in 2020; Panel B shows the colocated resident and fellow workspaces on the 7th floor of the new inpatient hospital building, opened in 2030.

Read the full article HERE.

Peer-Reviewed Publications

Ethical considerations in nutrition support because of provider bias

June 12, 2020 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The New Gastroenterologust
Publication Date: June 12, 2020
Authors: Diana C Anderson, David S Seres

Excerpt:

Medicine’s emotive harms
Clinicians hold more negative attitudes toward certain patients – our implicit bias. It has been suggested that nice patients may be preferred by clinicians and therefore receive more humanistic care. Clinicians hold more negative attitudes toward patients with eating disorders than toward other patients.

Cases of starvation caused by eating disorders are often seen by clinicians as a form of deviance, which provokes a visceral reaction of anger and frustration. These reactions have been associated with patients’ lack of improvement and personality pathology and with clinicians’ stigmatizing beliefs and inexperience. One could argue that this type of unconscious partiality may be worse than intentional harm.

Read the full case report and ethics discussion HERE.

Peer-Reviewed Publications

Keeping a 2009 Design Award-Winning Intensive Care Unit Current: A 13-Year Case Study

May 26, 2020 / Dochitect / Design for Critical Care

Peer-reviewed publication

Publication: Health Environments Research and Design (HERD)
Publication Reference: 2020 May 26;1937586720918225. doi: 10.1177/1937586720918225. Online ahead of print.
Authors: Neil A Halpern, Diana C Anderson

Abstract

In a complex medical center environment, the occupants of newly built or renovated spaces expect everything to “function almost perfectly” immediately upon occupancy and for years to come. However, the reality is usually quite different. The need to remediate initial design deficiencies or problems not noted with simulated workflows may occur. In our intensive care unit (ICU), we were very committed to both short-term and long-term enhancements to improve the built and technological environments in order to correct design flaws and modernize the space to extend its operational life way beyond a decade. In this case study, we present all the improvements and their background in our 20-bed, adult medical-surgical ICU. This ICU was the recipient of the Society of Critical Care Medicine’s 2009 ICU Design Award Citation. Our discussion addresses redesign and repurposing of ICU and support spaces to accommodate expanding clinical or entirely new programs, new regulations and mandates; upgrading of new technologies and informatics platforms; introducing new design initiatives; and addressing wear and tear and gaps in security and disaster management. These initiatives were all implemented while our ICU remained fully operational. Proposals that could not be implemented are also discussed. We believe this case study describing our experiences and real-life approaches to analyzing and solving challenges in a dynamic environment may offer great value to architects, designers, critical care providers, and hospital administrators whether they are involved in initial ICU design or participate in long-term ICU redesign or modernization.

Keywords: architecture; critical care unit; design; intensive care unit; renovations.

Access the article HERE

Peer-Reviewed Publications

The Intersection of Architecture/Medicine/Quality and the Clinical Nurse Specialist: Designing for the Prevention of Delirium

December 2, 2019 / Dochitect / Design for Geriatrics, Design for Patient Safety, Evidence-Based Design

Peer-reviewed publication

Publication: Clinical Nurse Specialist (The International Journal for Advanced Nursing Practice)
Publication Reference: 34(1):5-7, January/February 2020
Author: Anderson, Diana C.; Jacoby, Sonya R.; Scruth, Elizabeth Ann

Excerpt:

“We call it the delirium room,” my colleagues would say about a hospital room where, anecdotally, it was noticed that more patients tended to become delirious. I went to visit it—the door squeaked with each swing, there was minimal daylight with the window view being a neighboring wall, and the room faced the constantly noisy nursing station.What insights can architectural design provide toward our understanding of delirium and models of care?

What if “the delirium room” did not incite delirium but instead prevented and even treated it?

Read more about Delirium and Design HERE.

Peer-Reviewed Publications

The convergence of architectural design and health – The Lancet

December 7, 2018 / Dochitect / Design for Clinical Staff, Evidence-Based Design, The Physician-Architect Model

Peer-reviewed publication

Publication: The Lancet
Publication Reference: December 7, 2018
Authors: Diana C Anderson, Steph A Pang, Desmond O’Neill, Eve A Edelstein

View Article

The Lancet features Architectural Design and Health!

“During my medical residency, I realized how much burnout affected us as trainees on the front lines of care. In particular, I noticed that much of that difficulty was tied to the areas in which we worked—constant noise, poor lighting, and lack of daylight. Space design made patient care challenging at times, too; for example, not being able to access the correct side of my patient to perform the physical exam as I had been taught. I often considered that the built environment could improve care delivery with more collaboration amongst designers and clinicians.”— Diana Anderson

The disciplines of public and environmental health have long recognised the impact of the built environment on health. Yet clinicians have limited opportunity to engage with architects and design professionals, and the impact of health-care design is largely absent from health policy discussions. However, this is beginning to change.

Read more HERE!

Peer-Reviewed Publications

1 2 3