Hospital Physical Environment Impact on Safety and Patient Flow
The Center for Health Design
is an advocacy and research organization that brings architects and
hospital folks together to build new hospitals that are more efficient
and safer for patients. Since they're design guys, they have a pretty
cool web site too. I've referred to their work a number of times in the
past, and they've just released a 100 page abstract table (pdf file) to go with a research report (pdf file) they posted some time ago.
in US history. As a result of a confluence of the need to replace aging
1970s hospitals, population shifts in the United States, the graying of
the baby boom generation, and the introduction of new technologies, the
United States will spend more than $16 billion for hospital
construction in 2004, and this will rise to more than $20 billion per
year by the end of the decade. These hospitals will remain in place for
decades.
In this project, research teams from Texas A&M University and
Georgia Tech combed through several thousand scientific articles and
identified more than 600 studies – most in top peer-reviewed journals -
that establish how hospital design can impact clinical outcomes. The
team found scientific studies that document the impact of a range of
design characteristics, such as single-rooms versus multi-bed rooms,
reduced noise, improved lighting, better ventilation, better ergonomic
designs, supportive workplaces and improved layout that can help reduce
errors, reduce stress, improve sleep, reduce pain and drugs, and
improve other outcomes. The team discovered that, not only is there a
very large body of evidence to guide hospital design, but a very strong
one.
Another one of their findings is the impact variable acuity units (aka
flexible monitoring, universal units, house-wide monitoring) have on
reduced length of stay (LOS) and outcomes.
New Official Definition of Interoperability
According to 35 organizations and the National Alliance for Health Information Technology (NAHIT), the term interoperability means:
information technology systems and software applications to
communicate, exchange data accurately, effectively and consistently,
and to use the information that has been exchanged
The definition is intended to be used in policy and legal
contexts and
as a guiding principle for technical specifications. From the press
release: “In just a few short months, The National Alliance for Health
Information Technology has succeeded in building widespread industry
agreement on a definition for interoperability in healthcare, a crucial
step to ensuring that hundreds of thousands of healthcare information
technology systems will some day be able to exchange critical patient
data.” Be still my heart. While all great deeds start with a first
step, it seems their definition is remarkably close to what the IEEE defines as the meaning for “interoperability.” Isn't this just “plug and play” connectivity by another name?
Back in my DICOM
days, interoperability meant that one system or application could control another. I think a more accurate definition of
interoperability would be:
services to and accept services from other systems, and
to use the services so exchanged to enable them to operate effectively
together.
One system passing data to another that then processes, stores or forwards that information is using an interface,
which seems to fit the NAHIT's definition. The following is a scenario
for interoperability: A medical device sends an alarm to a
clinical information system which applies the alarm and what it knows
about the patient to a rules engine, then sends a message to the
patient's physician and instructs the medical device to cease therapy.
Admittedly, that's way beyond what the NAHT is contemplating. Some vendors are already working on these capabilities.
[Hat tip: AHA News]
