Life Saving Design

To minimize the risk of infection, orthopedic operating rooms require a precise air-flow pattern, in which air is introduced into the room and moved past the surgeons, technicians, and the patient, across the operating table, then picked up and returned low to the ground, around the room’s perimeter areas. In hospitals, especially in surgical settings, the biggest threat of infection for patients comes from other people. By moving the air past the doctors, nurses, and technicians, over the patient, and then down, designers can keep as much of the “dirty” air as possible away from the patient.

In addition to the functionality of individual spaces, health care architects also must understand the ways in which facility layout positively affects the patient experience. “For example, the radiology department needs to be directly connected to the [emergency department], or the ED can’t function,” Zborowsky explains. “It might even compromise patient care if you have to take those patients too far from the ED to get a CT scan. So really understanding the functional nature of these areas—that’s what sets firms apart when they’re doing health care planning and design.”

That might sound purely intuitive, but Hintz says health care organizations continue to enlist firms that don’t have the experience necessary to anticipate these key “adjacencies,” as they’re called. One such project is currently under construction in the Twin Cities, he reports. The facility’s emergency department and the urgent care site are on opposite ends of the campus. “If you’ve dealt with this market for very long,” Hintz says, “you know people walk into EDs, and they shouldn’t be there—they simply have colds and they should be diverted fairly easily to the urgent care site. Or someone walks into the urgent care with chest pains, and they should be directed to the emergency side. And you certainly don’t want to send the chest-pain patient on a two-block hike. So to put the ED and the urgent care on opposite ends of the campus is really regrettable.”

Healing Environments

Yet it’s no longer enough for architects to have a command of regulatory requirements and a healthy respect for functional relationships. Evidence-based design now enables health care specialists to create patient-centric environments that positively influence patient outcomes by decreasing instances of nosocomial infection (those contracted inside hospitals) for example, and shortening lengths of stay.

“The whole notion of building buildings to react positively to patient outcomes is wrapped into a larger concept of a holistic healing environment, and really looking at the patient as a person with physical, social, psychological, and spiritual needs,” Zborowsky says. “We know every human being has at least some of those things, so we need to look at the patient more holistically. I can’t think of a client lately that hasn’t wanted to talk that way about their patients.”

Perhaps the most significant design change to emerge of late is the move to private rooms. “We know from the existing literature that we need to move to private rooms because the research supports the decrease in the transfer of infection in a private room, versus putting patients together in a room,” Zborowsky says.