SAN DIEGO — Modern medical care continues to advance and improve at a rapid pace, and today’s doctors and surgeons have never been more skilled or well-informed. However, sometimes it’s the little things that make a major medical difference. Researchers from the University of Michigan report that certain hospital room qualities — such as having a window view, staying in a single room, or closer proximity to a nursing station — may influence outcomes following high-risk operations.
The United States spends roughly $50 billion annually on the construction of health care facilities. Beyond the obvious need for state-of-the-art facilities, prior research suggests architecture and interior design can enhance patient care and outcomes. A seminal study published in 1984 found that providing patients with a window view may influence surgery recovery. Other studies have found that severely ill patients assigned to ICU rooms that are “not well visualized” by the medical staff may be more likely to experience worse health outcomes.
So, while there was some precedent to the notion that the right hospital room can make all the difference, few projects had actually investigated how room features such as single versus double occupancy, distance from a nursing station, and a window view may impact clinical outcomes. The team at the University of Michigan set out to better understand if various hospital room features really can impact mortality and length of stay outcomes post-surgery.
“We were fascinated to see from a previous study that mortality was different in rooms that were in the line of sight of a nurse’s station. Nurses could more readily assess the patient’s condition and intervene more quickly in severe events. We wanted to see how this finding would play out at our institution, specifically in a surgical population,” says study co-author Mitchell J. Mead, a health and design scholar at the University of Michigan, in a media release. “One of the next big steps for health care design is to understand these pathways of causation that can lead to different clinical outcomes in patients staying in hospital rooms with different features.”
A window can cut the risk of death by 20 percent
This single-site study involved 3,964 patients who underwent 13 high-risk surgeries (including colectomy, pancreatectomy, and kidney transplant) at the University of Michigan Hospital between 2016 and 2019. The patients had been admitted to rooms on two hospital floors.
These patient rooms were coded based on various features: window or no window, single occupancy, double occupancy, distance to the nursing station, and line of sight to clinicians. Study authors linked patient encounters according to room number, which helped identify clinical outcomes, including mortality and length of stay, related to room design.
The study’s key findings include:
- Mortality rates among high-risk surgeries varied across room design features and room types.
- Room features that influenced clinical outcomes after surgery included distance from a nursing station, single room occupancy, and having a direct line of sight by which clinicians could see into the room.
- Mortality rates were 20 percent higher (odds ratio 1.2) if patients were admitted to a hospital room without a window than if they were put in a room with a window. This held true even after researchers accounted for patient co-morbidities and complexity of the operation.
- Among patients staying in a room without a window, 30-day mortality rates were 10 percent higher (odds ratio 1.1).
- While mortality rates varied across room designs, mortality rates did not vary by room type when length of stay was considered. This suggests length of stay does not account for differences in mortality.
“This investigation provided evidence that patients had differential outcomes across room design features, when accounting for clinical risk, and warrants further investigation for how hospital design may be influencing outcomes,” Mr. Mead adds.
Who gets the best rooms in a hospital?
When researchers assessed different rooms based on the favorable design features, it became apparent that sicker patients tend to be assigned single rooms, closer to a nursing station and within direct line of sight, and a window view. According to study co-author Andrew M. Ibrahim, MD, MSc, assistant professor of surgery, architecture, and urban planning at the University of Michigan and co-director of the Center for Outcomes and Policy, this study is just one illustration of the overlooked relationship between hospital design and patient care and outcomes. Investing in researching the best design features could potentially help countless patients.
“I think we can get a much better return on what we build and hopefully design safer, healthier hospitals,” he says.
Moving forward, study authors would like to see future projects analyze outcomes across multiple hospitals. They are already in the process of replicating a similar study across Michigan Medicine and are hoping to recruit collaborators across other hospital systems. They also plan to expand the scope of study to include other metrics such as pain medication use and patient satisfaction across room types.
“The common question we get asked is, do you want us to rebuild our hospitals? Of course, that is not practical. But we do recognize clear patterns where certain room types have better outcomes after surgery,” Dr. Ibrahim concludes. “We can start to prioritize the sickest patients there. Just the way we have developed precision health models for getting the right care to the patient, there may be a corollary for the right room for the right patient and procedure to optimize outcomes collectively.”
The team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022.