Rx: Design - A Blueprint for Healthcare Change
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1 Rx: Design - A Blueprint for Healthcare Change Diana Anderson, MD, M.Arch Physician, American Board of Internal Medicine (ABIM) Architect, American College of Healthcare Architects (ACHA) Fellow, Human Experience Lab, Perkins+Will HealthAchieve I Toronto I November
2 Outline Architecture, Medicine + the GAP Rx: Design 1. The hybrid professional 2. Research-based design 3. Patient mobility 4. Clinician wellbeing Disruptive Innovation + Future Thinking
3 An organism structure A city street structure Borasi Giovanna, Zardini Mirko (2012). Imperfect Health: the medicalization of architecture. Lars Muller Publishers, Canadian Center for Architecture, p14
4 ARCHITECTURE MEDICINE THE GAP
5 design intent Once challenged, the architect will find completely new shapes and means to produce the hospital, but he cannot know what the doctor knows. Louis Kahn, Architect user experience
6 New York-Presbyterian Archives
7
8 Historical Convergence of Architecture & Medical Practice architecture medicine The TB Sanatorium Model
9 Therapeutic success The hospital as a medical instrument Paimio Sanatorium, Finland Architect Alvar Aalto
10 Paimio Sanatorium, Finland Architect Alvar Aalto
11 the benchmark for modern hospital design
12 Smith Jeanette. The Doctor Henri Vasquez ( ), Cardiologist Edouard Vuillard. JAMA;315(3):
13 What drives the change in hospital architecture? The hospital is a human intervention and as such, can be reinvented at any time. Leland Kaiser, Hospital Futurist Adams, Annmarie (2016). Canadian hospital architecture: how we got here. CMAJ;188(5):
14 The Future Convergence of Architecture & Medical Practice architecture evidence humanities aging population simulation medicine
15 A True Anastomosis of Fields Enduring connection- clinical practice + design
16 Medicine & Architecture: From Infrequent Intersection to Atypical Anastomosis
17 WHAT ABOUT EVIDENCE?
18
19
20
21 PATIENT MOBILITY
22 Can architecture affect our health? Hazards of hospitalization The negative effects of hospitalization begin immediately & progress rapidly functional decline from baseline occurs by the second day of hospitalization and improves little by discharge. Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):
23 Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3): Cascade to Dependency Muscle Strength & Aerobic Capacity Vasomotor Instability Bone Density Ventilation Sensory Continence Altered Thirst & Nutrition Fragile Skin Tendency to Urinary Incontinence Immobilization High Bed Rails Plasma Volume Accelerated Bone Loss Closing Volume Sensory Depravation No Glasses or Hearing Aid Barriers Tether Rx Diet Immobilization Shearing Force Barriers Tethers Dehydration Malnutrition Functional Incontinence Syncope po 2 Delirium Tube Aspiration Catheter Family Rejection Deconditioning Fall Physical Restraint Chemical Restraint Pressure Sore Fracture False Label Tardive Dyskinesia Infection NURSING HOME
24 Patient Room Design Should the bed still be the focal point? I know of no evidence that shows the therapeutic value of bed rest. Morton Creditor, MD Creditor M. Hazards of Hospitalization of the Elderly. Annals of Internal Medicine, 1993;118(3):
25 Patient Safety Where are falls occurring in the hospital? Previous studies have indicated that most patient falls occur in the bedroom, during transfers to and from the bed, followed by the bathroom during toileting activities. Hitcho EB, Krauss MJ, Birge S, et al. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med. 2004;19:
26 Room Design and Patient Falls What is the evidence?
27 Patient Safety Where are falls occurring in the hospital? Presented at Medicine Grand Rounds Columbia University Medical Center Anderson DC, Postler TS, Dam TT. Epidemiology of Hospital System Patient Falls: A Retrospective Analysis. American Journal of Medical Quality Apr 8.
28 Design & Patient Fall Results Fall locations in the hospital Anderson DC, Postler TS, Dam TT. Epidemiology of Hospital System Patient Falls: A Retrospective Analysis. American Journal of Medical Quality Apr 8.
29 Design & Patient Fall Results Fall locations in the hospital Results Fall locations across the hospital campus Anderson DC, Postler TS, Dam TT. Epidemiology of Hospital System Patient Falls: A Retrospective Analysis. American Journal of Medical Quality Apr 8.
30 Design & Patient Fall Results Do fall protocols help? Results Do fall protocols help? Anderson DC, Postler TS, Dam TT. Epidemiology of Hospital System Patient Falls: A Retrospective Analysis. American Journal of Medical Quality Apr 8.
31 Design & Patient Fall Results Which age groups are falling? Anderson DC, Postler TS, Dam TT. Epidemiology of Hospital System Patient Falls: A Retrospective Analysis. American Journal of Medical Quality Apr 8.
32 CLINICIAN WELLBEING
33
34 I m on night float... and just covering
35 Where staff should be able to go
36 where we actually can go
37 Clinician Burnout Many doctors describe training as a soul crushing boot camp, a dehumanizing nightmare.
38 Night Float Demise of the on-call room? With the new work hour restrictions, residents shouldn t need sleeping quarters anymore - Hospital Administrator
39 Clinician Well-Being & Health UofTMed Magazine
40
41 Clinician Activities & Workspace Access to daylight for staff 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):
42 Innovative Solutions for Light Alfred ICU, Melbourne, Australia
43 Innovative Solutions for Light Montreal General Hospital, Montreal, Canada
44 Mount Sinai Emergency Department, New York City, NY, USA
45 Designing for Collaboration The Salk Institute, La Jolla, California ( ) Terrence Donnelly Center, Toronto, Canada (2005)
46 Designing for Collaboration 80% of scientific breakthroughs occur outside the laboratory environment in social settings Jen, L. Genetic complement. Canadian Architect. 2006;51:28-33.
47 What Happened to the Doctors Lounge? With the doctor s lounge now almost non-existent, where is the new hub of activity where relationships will have a chance to thrive? CFPC/RCPSC Conjoint Discussion Paper,
48 Our New Meeting Place? Lets take the stairs
49 Design Trends Going Forward Although only medical anecdotes, these eventually lead to confirmation studies and change follows. - D. Kirk Hamilton, Healthcare Architect
50 DISRUPTIVE INNOVATION
51 Healthcare Design Hoof Beats: Is it Time to Think Zebras Instead of Horses?
52 The complexity of medicine now exceeds the capacity of the human mind. Obermeyer Z, Lee, H. Lost in Thought The Limits of the Human Mind and the Future of Medicine. N ENGL J MED ;13:
53 Neurocognitive Disorder How should we address wandering?
54 Neurocognitive Disorder How should we address wandering? Floor patterns to limit wandering? Freedom of movement & meaningful activity?
55 Halpern NA, Anderson DC, Kesecioglu J. ICU Design in 2050: looking into the crystal ball! Intensive Care Medicine DOI /s x.
56 A return to the past to achieve the future?
57
58 Rx: Design A Blueprint for Healthcare Change Diana Anderson, MD, MArch diana.anderson@dochitect.com HealthAchieve I Toronto I Nov
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