Publication type: "Peer-Reviewed Publications"

Decentralization: The Corridor Is the Problem, Not the Alcove.

December 5, 2017 / Dochitect / Design for Critical Care, Evidence-Based Design

Peer-reviewed publication

Publication: Critical Care Nursing Quarterly
Publication Reference: 2018 Jan/Mar;41(1):3-9
Authors: D. Kirk Hamilton, Sandy M. Swoboda, Jin-Ting Lee, Diana C. Anderson

Abstract

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.

Peer-Reviewed Publications

Architectural Armor: Preventive Biocidal Surfaces

October 23, 2017 / Dochitect / Design for Patient Safety, Evidence-Based Design

Letters to the Editor

Publication: Health Environments Research & Design Journal, Letter to the Editor
Publication Reference: 2017, Vol. 10(5) 162-164
Author: Diana C. Anderson, MD, MArch, Ken Trinder, Kate Mitchell, and Erica Mitchell
View Article

Excerpt: Currently, there are two materials that qualify as preventive biocidal surfaces. Copper and copper alloys are one material. There is now an additional material that suspends cuprous oxide in a polymer, resulting in an equally efficacious substance that can be used both as a slab and as injection-molded shapes. Distinguishing itself from copper alloys, the cuprous oxide in a polymer looks and feels like any other synthetic quartz surface with a smooth, natural stone appearance, without rusting or oxidizing, and fabricates like any other hard surface, with lower cost implication.

For more information, read more about EOS Surfaces here.

Click here to read this Letter to the Editor, in which the evidence of Preventive Biocidal Surfaces is explored.

Letters to the Editor, Peer-Reviewed Publications

ICU Design in 2050: Looking into the Crystal Ball!

March 17, 2017 / Dochitect / Design for Critical Care

Peer-reviewed publication

Publication: Intensive Care Medicine Journal
Publication Reference: Published online March 17, 2017
Author: Neil A. Halpern, Diana C. Anderson, Jozef Kesecioglu
View article

Some questions, but no answers yet: will illnesses, diagnostics and therapies be very different in 2050 than today? Will acute or chronic organ failure, immune or genetic problems, or sepsis be addressed with supportive care or bioartificial organ replacements, primary organ regeneration or other interventions at the genetic, cellular or immunologic levels? What will technology, connectivity and informatics advances look like? The answers to these questions will all ultimately impact intensive care unit (ICU) design going forward.

Click here to read more about Dochitect’s vision for the future of ICU design.

Peer-Reviewed Publications

Consider the Benefits of Virtual Windows for Clinicians and Healthcare Staff

September 19, 2016 / Dochitect / Design for Clinical Staff

Letters to the Editor

Publication: Health Environments Research & Design Journal, Letter to the Editors
Publication Reference: 2016, Vol. 10(1) 172-173
Author: Diana C. Anderson, MD, MArch
View article

Excerpt: Architects and hospital designers have a duty to minimize the stress associated with illness and hospitalization through environmental factors, but also have the opportunity to advocate for the mental and physical needs of the physicians and healthcare workers themselves. While patients generally can spend days to weeks in healthcare settings, clinical staff may spend countless days, nights, and years working in windowless spaces.

Click here to read this Letter to the Editor, in which Dochitect considers the benefits of virtual windows for clinicians and healthcare staff.

Peer-Reviewed Publications

Epidemiology of Hospital System Patient Falls: A Retrospective Analysis

April 8, 2015 / Dochitect / Evidence-Based Design

Peer-Reviewed Publication

Publication: American Journal of Medical Quality
Publication Date: Am J Med Qual. 2015 Apr 8. pii: 1062860615581199.
Authors: Diana C. Anderson, MD, MArch, Thomas S. Postler, PHD, Thuy-Tien Dam, MD

Abstract

Patient falls are the most common type of in-hospital accidents. The objective of this retrospective descriptive study was to describe the locations and characteristics of hospital-related falls. Data on patient characteristics, including locations and fall circumstances, were collected through incident reports and medical records. A total of 1822 falls were documented at a 921-bed, urban academic hospital center over a one-year period; 1767 (97.0%) of the falls occurred in the hospital setting, 55 (3.0%) in ambulatory care. The majority of falls (80.8%) occurred within inpatient units; the remainder within the greater hospital campus. In all, 73.4% of fallers had fall prevention protocols implemented prior to the fall. The youngest age group (≤49 years) had the highest percentage of fallers. This study provides novel insights into variables found to be associated with falling, including location of falls within the hospital campus, efficacy of fall prevention protocols, and age groups.

Additional Press:

Note This research was presented at Medicine Grand Rounds, Department of Internal Medicine Resident Research Day, Columbia University Medical Center, March 26, 2014:

2014 Resident Research Poster_compressed copy

Lectures, Peer-Reviewed 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

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
View article

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

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.
View article

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
View article

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

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
View article

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

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