Agency for Health Care Administration (AHCA) 31st Annual Seminar October 13 th 2015, Orlando, Florida

Transcription

1 FINDING RESPITE IN THE MOMENT: DESIGNING FOR CLINICAL STAFF Agency for Health Care Administration (AHCA) 31st Annual Seminar October 13 th 2015, Orlando, Florida Diana Anderson, MD, M.Arch, LEED AP Architect (OAQ), Royal Architectural Institute of Canada Physician, Internal Medicine (Board-Eligible)

2 THE ART OF MEDICINE

3 OUTLINE Design for Patients The window bed Hazards of hospitalization Design layout & mortality Early integration of palliative care Design for Clinical Staff Where providers spend their time Access to daylight The burnout phenomenon Physical exam convention Collaboration & transition to interdisciplinary care The changing face of medical training Design Trends Going Forward

4 RX WINDOW BED FROM ANECDOTE TO REALITY

5 SOURCE: Anderson DC, Hamilton DK. Rx: Window Bed. Old Lives Tales. JAGS 2014;62(2): SOURCE: Shaw PA, Anderson DC. A View From and On the Window. Letter to the Editors, HERD 2014;7(4): RX WINDOW BED FROM ANECDOTE TO REALITY

6 MR. R AND THE BRIDGE

7 DESIGN LAYOUT & MORTALITY Results: Overall hospital mortality did not differ among patients assigned to LVRs vs HVRs Severely ill patients (those with Acute Physiology and Chronic Health Evaluation II scores >30) had significantly higher hospital mortality when admitted to an LVR than similarly ill patients admitted to an HVR (82.1% & 64.0%, n=39 & 75; P=.046) Conclusions: Severely ill patients may experience higher mortality rates when assigned to ICU rooms that are poorly visualized by staff. SOURCE: Leaf DE, Homel P, Factor PH. Relationship between ICU design and mortality. Chest May;137(5):

8 HAZARDS OF ELDERLY HOSPITALIZATION The negative effects of hospitalization begin immediately and progress rapidly. For the elderly patient population functional decline from baseline occurs by the second day of hospitalization and improves little by discharge. SOURCE: Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):

9 THE INTENSIVE CARE UNITS ICU ACQUIRED WEAKNESS In the absence of voluntary contraction, muscle strength for elderly patients decreases by 5% per day. Young patients on bedrest lose muscle strength at a rate of 1-1.5% per day (10% per week). SOURCE: Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):

10 THE CASCADE TO DEPENDENCY SOURCE: Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):

11 THE PATIENT ROOM - UNINTENDED BED REST 35 NSF 270 Net Sq Ft I know of no evidence that shows the therapeutic value of bed rest. SOURCE: Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):

12 THE PATIENT ROOM - UNINTENDED BED REST

13 PALLIATIVE CARE WHEN IS TO EARLY TO START? Several randomized studies involving patients with advanced cancer show that integrating specialty palliative care with standard oncology care leads to significant improvements in quality of life and care and possibly survival. SOURCE: Parikh RB et al. Early Specialty Palliative Care- Translating Data in Oncology into Practice. NEJM, 2014;369(24):

14 PALLIATIVE CARE WHEN IS TO EARLY TO START? SOURCE: Parikh RB et al. Early Specialty Palliative Care- Translating Data in Oncology into Practice. NEJM, 2014;369(24):

15 RESOURCES IN HEALTHCARE SOURCE:

16 RESOURCES IN HEALTHCARE DESIGN The move beyond uni- or multi-disciplinary care towards inter-disciplinary patient health care.

17 SOURCE: Block L, et al. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med Aug;28(8): WHERE PROVIDERS SPEND THEIR TIME 9% 15% 12% PROVIDER TIME SPENT 64% Indirect Patient Care Direct Patient Care Educational Activities Misc Activities

18 SOURCE: Block L, et al. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med Aug;28(8): WHERE DO TRAINEES SPEND OUR TIME? Compared with studies prior to 2003, interns spend less time in direct patient care, and more time talking with other providers and documenting.

19 THE CORRIDOR POTENTIAL WORK AND THERAPY ZONE?

20 ACCESS TO DAYLIGHT FOR STAFF NO SUN ZONE

21 INNOVATIVE SOLUTIONS FOR LIGHT Alfred ICU, Melbourne, Australia

22 INNOVATIVE SOLUTIONS FOR LIGHT Paimio Sanatorium, Finland

23 BURN OUT AND THE ENVIRONMENT Evidence is starting to accumulate that burned-out doctors make more errors, are more prone to substance abuse and depression. SOURCE: Ofri D. The Epidemic of Disillusioned Doctors. Time. Online July 2, 2013.

24 INTO THE TRENCHES

25 WHERE STAFF SHOULD BE ABLE TO GO...

26 .COMPARED TO WHERE WE CAN GO Places of Respite - Where can I go to compose myself?

27 THE PHYSICAL EXAM CONVENTION The Physical Exam Convention Medical Convention: Examine from the Patient s Right-Hand Side SOURCE: University of Toronto, Faculty of Medicine, ASCM Teaching Videos

28 THE PHYSICAL EXAM CONVENTION Ambulatory Care Can I examine from the right?

29 AMBULATORY CARE IS THE EXAM TABLE BECOMING OBSOLETE?

30 ROUNDING A TIME FOR COMMUNICATION Communication failure among healthcare providers is one of the most frequently cited causes of preventable harm to patients. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Medical Surgical SOURCE: Agency for Healthcare Research and Quality, June 2008

31 DESIGNING FOR COLLABORATION The Salk Institute, La Jolla, California ( ) Terrence Donnelly Center, Toronto, Canada (2005)

32 DESIGNING FOR COLLABORATION 80% of scientific breakthroughs occur outside the laboratory environment in social settings The Salk Institute, La Jolla, California ( ) Terrence Donnelly Center, Toronto, Canada (2005) SOURCE: Jen, L. Genetic complement. Canadian Architect. 2006;51:28-33.

33 WHERE IS THE MD LOUNGE? The image of the doctor s lounge has been used to illustrate a place where collegial relationships flourish. With the doctor s lounge now almost non-existent, where is the new hub of activity where such relationships will have a chance to develop & thrive? SOURCE: CFPC/RCPSC Conjoint Discussion Paper,

34 OUR NEW MEETING PLACE? LETS TAKE THE STAIRS

35 AT NIGHT, THE HOSPITAL CHANGES

36 NIGHT FLOAT DEMISE OF THE ON-CALL ROOM?

37 NIGHT FLOAT - DEMISE OF THE ON-CALL ROOM? With the new work hour restrictions, residents shouldn t need sleeping quarters anymore - Hospital Administrator

38 NIGHT FLOAT - DEMISE OF THE ON-CALL ROOM?

39 DESIGNING TO BREAK BARRIERS Can the design of the environment soften the metaphor of the hospital as a battleground for trainees? Can better design be an influence in the model for behavioral change? YES! The building is becoming part of the operational solution

40 DESIGN TRENDS GOING FORWARD Although only medical anecdotes, these eventually lead to confirmation studies and change follows. - D. Kirk Hamilton, Healthcare Architect

41 Thank You! Diana Anderson, MD, M.Arch, LEED AP Architect (OAQ), Royal Architectural Institute of Canada Physician, Internal Medicine (Board-Eligible)