Bad Hospital Design Is Making Us Sicker

Bad Hospital Design Is Making Us Sicker

written by: Dhruv Khullar

by: Dhruv Khullar
Hospital room Hospital room

As a medical resident working 30-hour shifts, I quickly came to cherish those rare moments when I could duck out of the bustling and brightly lit hospital corridors and lay my head on a pillow.

Granted, it was often in a barren call room with a stiff mattress and a rumbling heater. There I'd lie, counting the seconds before an alarm sounded to alert me that a patient might have shifted in bed or an IV medication finished, or an overhead page called some doctor (please, not me!) to some floor to deal with yet another issue.

But as hard as it might be for doctors to rest in the hospital, it's infinitely harder for patients.

I see this every time I trudge from my call room to a patient's room. I tiptoe past Bed A to Bed B, where a patient might be moaning in pain or coughing uncontrollably. The patient is not the only one suffering: His roommate, typically separated by a flimsy curtain, also can't sleep a wink all night.

As a doctor, I'm struck daily by how much better hospitals could be designed. Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we've been building them all wrong — and that the deficiencies aren't simply unaesthetic or inconvenient. All those design flaws may be killing us.

It's no secret that hospital-acquired infections are an enormous contributor to illness and death, affecting up to 30 percent of intensive care unit patients. But housing patients together very likely exacerbates the problem. Research suggests that private rooms can reduce the risk of both airborne infections and those transmitted by touching contaminated surfaces. One study reported that transitioning from shared to private rooms decreased bacterial infections by half and reduced how long patients were hospitalized by 10 percent. Other work suggests that the increased cost of single-occupancy rooms is more than offset by the money saved because of fewer infections. Installing easier-to-clean surfaces, well-positioned sinks and high-quality air filters can further reduce infection rates.

Falls in the hospital are another major problem, leading to serious injuries, longer hospital stays and significant costs. Trying to navigate the unfamiliar space of a hospital room, often while disoriented by pain and medications, makes many patients susceptible to falling. A number of design factors contribute: poorly lit areas, slippery floors, toilets that are too high or too low. How quickly staff members can reach patients also makes a difference. For example, decentralized nursing stations that are closer to patient rooms and allow nurses direct lines of sight to beds can reduce the risk of falls and injuries.

There's also much we can do to improve the patient experience, which, of course, is inextricably linked to how well patients rest and recover. Privacy remains a challenge in hospitals, despite laws like the Health Insurance Portability and Accountability Act, a federal law known as Hipaa meant to protect patient privacy. As doctors, we're taught not to talk about patients in elevators, yet we routinely discuss their sexual or drug history in rooms while a stranger on the other side of a curtain can hear every word. Research has found that almost all physicians breach confidentiality in this way, and that patients in curtained spaces are more likely to withhold parts of their medical history or refuse parts of the physical exam.

And then there's the problem of noise. The average noise level in hospitals far exceeds guideline-based recommendations, making it hard for patients to sleep. Reducing exposure to noise — through earplugs, sound-absorbing acoustic panels, quieter staff conversations, and fewer unnecessary alarms — can improve the quality of patients' sleep.

Some of the most interesting research on the way hospitals are built examines the role of nature to promote healing. Research pioneered by Roger Ulrich, now a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden, suggests that when it comes to recovering from illness, the more nature the better. But too often patients and physicians find themselves cooped up in dim rooms and sterile hallways with little access to natural light or views of nature: too much concrete, not enough jungle.

Dr. Ulrich's early work explored how patients recovered after gallbladder surgery based on whether they were assigned to a room with a window that had a view of nature or of a brick wall. The study, now one of the most widely cited in the hospital design literature, found that patients looking out at trees had shorter hospital stays and took fewer pain medications than those viewing a brick wall.

Dr. Ulrich said the idea for the study came from his personal experience with illness. "As a teenager, I had some serious illnesses that forced me to spend time at home in bed," he told me. "My window was my compass of stability. Every day, I watched the trees in the wind. There was something endlessly calming about it."

Similar research has found that patients with bipolar disorder who are randomly assigned to brighter, east-facing rooms with morning sunlight had hospital stays nearly four days shorter than those with west-facing rooms. Even just images of nature may be beneficial. One study found that psychiatric patients tend to require far fewer medications for anxiety and agitation when photos of landscapes hang on hospital walls compared to walls adorned with abstract art or left bare. And people watching videos of nature seem to have higher tolerance for pain, more positive emotions, and lower heart rates and blood pressure.

"Hospitals can be dangerous and unpleasant," Dr. Ulrich said. "But there's a lot we can do to keep patients safe and help them recover."

Research supports an urgent need to change the way we build, maintain and work in hospitals, and many facilities could do more to promote rest and healing while preventing stress and infection. It's clear that evidence-based medical care will require evidence-based hospital design.