Room to Heal – Modern Hospital Design Emphasizes Privacy, Peace of Mind

It’s called ‘ICU psychosis.’

That’s a broad term for a cluster of symptoms of delirium — ranging from agitation and lethargy to confusion and hallucinations — that can affect patients in an intensive-care unit. And they can be exacerbated when patients can’t tell day from night.

So, in its recently remodeled ICU, Mercy Medical Center integrated a significant amount of natural lighting and large windows, said Jess Calcidise, vice president of Patient Care Services and chief Nursing officer.

“People have an internal clock, their circadian rhythm, and when you can’t differentiate between day and night, it can turn your whole cycle upside down,” she said. This can bring on symptoms of ICU psychosis, which can mess up sleep cycles and, in many cases, significantly delay recovery.

Decades ago, she said, conventional wisdom was to keep ICU patients in tiny cubicles within a dark, windowless room. “They thought that was the most healing environment. That was wrong.”

Mercy has undergone a broad renovation, one department at a time, over the past five years, she told HCN, and all the projects, in one way or another, have incorporated 21st-century hospital-design philosophies, natural light in the ICU being just one of them.

Another is the incorporation of a family sleeping area, with pull-out beds, in ICU rooms, so family members don’t have to leave the patient’s bedside. “What we found is that the family is really conducive to healing,” Calcidise said. “In the old days, they had to wait in the waiting room.” The ICU also features a low-lit den area for relaxing when the patient needs to be alone; that space also includes a shower for the use of family members.

Calcidise then showed HCN the Intermediate Care area, a step down from the ICU along the continuum of getting patients well enough to return home. She pointed out the color scheme, an unobtrusive mix of soft earth tones, intended to be easy on the eye.

“We also have sound-absorbing tiles in the ceiling, as well as soft floors that help absorb some of the noise,” she explained. “Hospitals are noisy, so we looked for materials that absorb rather than vibrate throughout the building.”

Other area hospitals have incorporated similar color and lighting strategies in their recent renovation projects, while some have turned to ‘green’ design elements as well.

For instance, when Baystate Medical Center engineered its 640,000-square-foot, $296 million ‘hospital of the future’ expansion five years ago, it incorporated skylights to bring natural daylight to interior spaces, reducing energy requirements, and used energy-efficient lighting throughout; sensors rely on daylight wherever possible, and lower lighting levels at night. Patient rooms and family areas are located along exterior walls to maximize access to natural light.

Meanwhile, high-quality window systems assist with insulation, and the building’s cooling and air-handling systems are energy-efficient. Baystate also constructed a ‘green roof’ terrace that includes a walking trail and benches so that patients, family members, and staff can get outside and get refreshed. The space also helps with temperature control and water conservation, because it collects water for irrigation.

Private Matters

Still, perhaps no modern design trend has been as significant, in terms of patient health, than the move toward single rooms.

Over the past two years, Holyoke Medical Center has converted the majority of its patient rooms to private rooms, and there have been myriad benefits, said Jim Keefe, chief Nursing officer.

“The conversion has allowed for more space for patients, more privacy, and less difficulty selecting the right room for the right patient,” he explained. “You don’t have to worry about issues such as isolation for infectious disease, and it also reduces the noise level.”

And, overall, he added, patients just like it.

“Some may want a lot of visitors, and some may want less, so it’s a better fit for all patients, who know they have the room to themselves, and they can choose the number of visitors and interruptions.”

The rooms have been set up in such a way that they can be quickly converted back to double occupancy in case of a temporary surge, but, in most cases, patients are granted privacy. One reason hearkens back to the population-health model detailed in the story on page 12: there has been a downturn across the country in patient population as health systems are incentivized to reduce length of stay and rehospitalization rates, instead focusing on keeping patients well outside the hospital setting.

Calcidise, who noted that 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Mercy’s patient rooms are now private, said that, because of that paradigm shift, the patients who do stay in the hospital are sicker, on average, than ever before.

“Hospitals used to be populated with patients who no longer meet the critera for inpatients,” Keefe added. “So when we had an opportunity to renovate a space for inpatients, we took that opportunity to make it more conducive to private rooms.”

At the same time, she added, HIPAA regulations have intensified the need for privacy. “In a double room, if the patient is talking to the doctor, the other patient can hear about their illness or condition, so it’s not just a matter of personal space, but privacy of personal information,” he said.

Some benefits of a private room speak less to health and privacy than to simple patient satisfaction — among them the ability to choose one’s own TV shows or other entertainment, or choose not to be entertained at all — but those aspects matter too, he told HCN.

“Another concern is that the public is very astute to cleanliness,” Keefe said. “Even if the room is clean, if you’re asked to share the room with another patient, when you’re introduced to that environment as the second patient, the environment looks dirty. The first person is already by the window, you’re seeing an overflowing table full of that person’s belongings, the bed is unmade … it doesn’t have the feel of a terminally clean room.”

Finally, private rooms simply feel less cramped. “There’s more space for positioning a patient or helping them out of bed. You’re not as confined. When you convert a semi-private room to a private room, there’s a lot more space, and it’s much more comfortable.”

Investing in Patients

Renovating an entire hospital, unit by unit, to emphasize privacy, peace of mind, cleanliness, and any number of other priorities is no easy feat, Calcidise said, but patients at Mercy will benefit from the effort. “It was like a big puzzle; we had to keep patients moving through the system while we worked.”

Some of the changes speak to quality of life while spending time in the hospital, such as investments in smart TVs with gaming and movie options, and comfortable recliners for family members. Others are subtle. For example, medical devices and supplies, hand sanitizers, and other items that don’t exactly add to the visual appeal of a room are now placed outside the patient’s line of vision. Instead, the foot of the bed now features a flower shelf where visitors can leave gifts, pictured, and messages.

“That’s more uplifting than looking at the container of needle sharps,” Calcidise said.

It all speaks, however, to an evolution of healthcare that recognizes the value of basic human needs.

“Nurses have this tendency to be these nurturing people. Now we’re creating an environment where they can do that,” she said. “They’re not climbing over people. They can actually sit at the bedside — we brought in seating for healthcare workers; before, they stood at the foot of the bed and told you what was going on. People receive the information much better now. It feels like you’re talking to them, versus at them.”

In general, she told HCN, “we’ve moved away from institutional care. The whole dynamic has changed; we’ve become patient-centered. It’s about the family being involved and the vitality of our natural instincts for companionship, for natural light. Healthcare has changed significantly, and we’re changing the environment to match that.”