New research reports on the more unusual — and seemingly, inconsequential — elements that can improve patient outcomes following high-risk surgery. Having a window in the room is among them.
Nobody can deny that medicine has come a long way. Ancient doctors probably couldn’t even dream of having access to the tools, devices, and medicine that their modern counterparts use on a daily basis. And there are still more tools being developed in medicine even today: more capable drugs, healing microbots, and more refined imaging. But a new paper showcases some of the more unexpected and low-tech factors that seem to improve a patient’s chances of successfully recovering after surgery.
Factors like having a window view, being placed in a single room, or in closer proximity to a nursing station all influence patient outcomes after high-risk operations, the paper explains.
“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 healthcare design is to understand these pathways of causation that can lead to different clinical outcomes in patients staying in hospital rooms with different features.”
We don’t tend to think of architecture or interior design as something that could produce tangible medical benefits, but the results of this study strongly suggest that they do. The study that Mead highlights, published in 1984, was the first to show that patients in rooms with a window view may have improved recovery rates after surgery. Since then, other studies have also shown that patients assigned to ICU rooms that were not “well visualized” by the medical staff were statistically more likely to experience poorer health outcomes.
The current paper, written by researchers at the University of Michigan, comes to further our understanding of how hospital architecture can make a difference for patients’ health. It looked at the impact that factors such as room features, the number of occupants per room, and the distance from a nursing station can have on patients’ clinical outcomes.
The study followed 3,964 patients who underwent 13 high-risk surgeries such as colectomy, pancreatectomy, and kidney transplant at the University of Michigan Hospital between 2016 and 2019. All of them were afterward admitted to a room in one of two floors of the hospital. Each room was coded based on various features such as window / no window, single occupancy / double occupancy, distance from a nursing station, and line of sight of doctors. The researchers then linked patient encounters with each room number, allowing them to study how clinical outcomes varied per type of room design.
Some key findings include that mortality rates varied across room types and room design features. Distance from a nursing station, single room occupancy, and being in direct line of sight of clinicians had the largest effect on clinical outcomes.
Mortality rates were one-fifth (20%) higher overall for patients admitted in a room without a window compared to those in a room with windows; this effect was still observed even after accounting for patient co-morbidities and severity of surgery. Among patients in windowless rooms, 30-day mortality rates were 10% higher.
Although the team did see differences in mortality rates across different room designs, these mortality rates didn’t vary by room type when only length of stay was taken into consideration. This means that it wasn’t the amount of time spent in the hospital that accounted for the differences in mortality seen across room types.
“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 explains.
In the short term, such findings can help doctors make better choices of which patients are admitted into which rooms, so that those that are most at risk can be given the highest chance of pulling through. Relatively minor cases that are not life-threatening can be admitted to other rooms.
In the long term, they can help us better design new hospitals. This would allow each room — or as many as possible — to benefit from the factors that promote positive outcomes seen in this paper.
The study also showcases the fact that architecture and interior design can, surprisingly, be elements that play a part in the act of medicine. It opens up an intriguing and exciting line of research, one which could benefit patients across the world for relatively little cost or effort — hospitals have to be built either way; it would pay to build them right and get the most benefits out of their structure.
“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,” says 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.
“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 findings have been presented at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022.