QUALITY: To the Lighthouse of Reform Through Evidence-Based Design

Who said English Lit had nothing to do with health reform? When it comes to stopping the spread of deadly hospital-acquired infections having a room of one's own (although not necessarily a room with a view) can make a big difference, according to today's Los Angeles Times.

The CDC estimates that hospital-acquired infections take close to 100,000 American lives each year. Using the principles of evidence-based design, Bronson Methodist Hospital in Kalamazoo, Michigan reduced infection rates by close to 11 percent by switching from a multi-bed room facility to private rooms. Other design decisions that could improve care include:

• Ventilation systems and air filters to keep infections from circulating through the hospital
• Easily cleaned, nonporous surfaces (MRSAs love shag carpeting, but hate antimicrobial linoleum)
• Lots of sinks, with separate facilities in a room for patients and health care workers

The article highlights some impressive results from such evidence-based designs (many of which have been incorporated in the American Institute of Architects' guidelines for the design and construction of health care facilities). For example, one hospital in Indiana saw medication errors drop by 67 percent when it changed its coronary ICU to single-bed rooms.

More examples can be found at The Center for Health Design's Pebble Project, which highlights designs from various health care providers with the goal of generating a ripple effect of innovation throughout our health care system. The Barbara Ann Karmanos Cancer Institute, in Detroit, MI reduced medical errors 30 percent by better organizing medications and supplies, standardizing visual cues, and reducing noise levels. (We wrote recently about a recent study of how nurses spend their time that also called for better organization of supplies and equipment.)

The voyage out to a more efficient health care system may still be a bit long but small changes, from the floor plans of an ICU to the placement of oximeters can have a big impact. Now, if more medical providers could take E.M. Forster's advice and only connect! To health IT, that is.