New Hospital Incorporates Livable Features Proven to Speed Recovery

by U.S. Medicine

October 4, 2011

Fort Belvoir, VA – The new 120-bed Fort Belvoir Community Hospital (FBCH) is far from the typical hospital with institutional green cinderblock walls lining dark hallways.

The facility, which opened last month in the national capital region, has ample natural light and large windows that look out to nature. Pavilions that connect to the main hospital concourse are named for natural scenes, such as meadows and sunrise, and the patient rooms are designed with the idea that family members may sleep there, as well.

“It is one of the most technologically advanced in evidence-based design hospitals in the country today,” DeWitt Health Care Network Commander Col. Susan Annicelli  said at a press conference at the hospital in August. “It really provides an environment and backdrop that speaks to the commitment of world-class care for warriors past, present and for the families who have supported them over time.”

Evidence-based design (EBD), as defined by the Center for Health Design, is the process of basing decisions about structure design on credible research to achieve the best possible outcomes and is a growing trend in hospital construction around the country. “We are trying to break out of the mold of what people might think of when they think of a healthcare facility,” Debra Levin, president and CEO for the Center for Health Design, told U.S. Medicine. “It doesn’t need to be what you might conjure up in your mind.”

Evidence-based design principles

In some ways EBD is similar to evidence-based medicine, according to  Rick Repeta, MD, director of Integration and Transition at FBCH. 

“Really, what we are interested in is what is the best for the healing of the patient, for the speed of their recovery and for their perception of care. What evidence-based design helps us to do is to design a hospital to maximize those outcomes,” Repeta told U.S. Medicine.

The Walter Reed National Military Medical Center, another BRAC-mandated military facility in the Washington area, includes both new and renovated construction and incorporates elements of EBD. However, FBCH was different because it was built from the ground up and could be designed from scratch.

“We are one of, if not the first, DoD facility to be heavily invested [in EBD],” Repeta said.

Because studies suggest that exposure to natural light in the hospital can help patients recover, for example, it was heavily considered in the design of the facility. Large windows are in all of the patient rooms and throughout the facility so patients can look out at the trees and other greenery that surround the facility.

Outside gardens also are available for patients, their families and staff.

“There is a lot of good evidence that exposure to natural light reduces healing time. It improves patients’ perception of care,” said Repeta. “In many ways, that will improve their outcome, that is a part of the evidence behind this facility in bringing in all of the natural light.”

The hospital was also built with single patient rooms that include fold out beds for family members, private bathrooms and individual televisions. Single patient rooms are thought to reduce the spread of infections and have become the standard in most newly-constructed hospitals.

Areas of the hospital are color coded to help patients and their families find their way around.

In addition, smart suite technology will be incorporated into all of the patient rooms. Patients will see the photo and name of staff members on a screen before they enter the room.

Another EBD element is the way sinks are highlighted by mosaic tile on the wall to attract the attention of healthcare personnel.

New Hospital Incorporates Livable Features Proven to Speed Recovery Cont.

“Hospital-based infections are something that healthcare systems all across the country deal with and something we are very focused on at Fort Belvoir Community Hospital,” said Repeta. “So the idea of hand-washing is the best way that we know to prevent hospital-based infections. So what we have done is to use a few visual cues to try to help that process.”

Repeta said the design of the hospital makes it safer for staff in other ways, as well. Ceiling mounted lifts for heavy lifting of patients help reduce back injuries. The hospital also includes spongy carpeting designed to be easy on the feet and to reduce noise.

Col. Kathleen Ford, deputy commander for nursing at FBCH, said that patients who come to the facility may not know the term “evidence-based design,” but they will notice a difference between the new facility and the DeWitt Army Community Hospital that it replaces.

“We had a 1954 constructed hospital with shared spaces, dark rooms and narrow hallways. This facility is a million degrees away from that. I think the patient will be pleased to see the wide-open spaces and the connections with nature that we have achieved here,” she said.

EBD Research

Levin said that the money put into the construction of hospitals with EBD pays off of financially and healthwise for the patients.

“Without a doubt, there is evidence and research out there that show that spending some dollars up front will actually save you dollars year after year after year,” she said. “The other side is that it creates an environment that produces better health outcomes, a reduction in falls, a reduction of infections and a reduction in the use of analgesic drugs.”

Earlier this year a series of articles published in the January/February Hastings Center Report highlighted the payoff of adding these elements to a hospital. One of the articles noted that incorporating a number of EBD features into the construction of a 300-bed facility, such as larger windows, ceiling-mounted patient lifts, healing gardens, larger patient bathrooms with double-door access and hand-hygiene stations, would cost about $26 million more in construction. However, the article showed that the design could save about $10 million a year with reduced hospital stays, health-care associated infections and nurse injuries among other factors.

A case study at Sacred Heart Medical Center in Oregon found that after building a new hospital facility using EBD principles, including single patient rooms, large windows and ceiling mounted patient lifts, length of stay for patients decreased from 4.18 to 3.82 days. The cost per adjusted discharge was reduced by $790 per admission (from $14,559 to $13,769), or 5.4% and patient satisfaction rose to 86%.

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