Research Informed Design Supports Evidence-Based ICU Medicine

Abstract

The most recent version of the Society of Critical Care Medicine (SCCM) Design Guidelines (Thompson et al., 2012) offers multiple citations from the literature as justification for its performance recommendations. The SCCM leadership insisted that new guidelines for design and construction of ICUs should be evidence-based, insofar as possible. There is a growing recogni- tion that the environment plays a role in clinical outcomes, and a recognition that design of the environment is subject to a research-informed methodology. Not long ago I co-authored a book with Mardelle Shepley, Design for Critical Care: Evidence-Based Approach (2010), grounded in these same principles. The book makes use of numerous citations from multiple domains in the litera- ture to support its explanations and recommendations. More than 6 years ago I wrote an editorial for the European ICU Management journal, in which I con- tended that evidence-based design was emerging as a positive contribution to the performance of critical care, and a contributor to improved outcomes (Hamil- ton, 2006). I remain convinced.The practice of medicine based on relevant evidence is increasing, along with a systematic attack on error (Sackett et al., 1996). Peter Pronovost, MD, of Johns Hopkins, lost his father to a medical error while he was in medical school, and as a doctor went on to experience the disturbing and preventable loss of a child in his ICU. Josie King unnecessarily died of dehydration in one of the world's premier academic hospitals. Pronovost openly shares these horrific exper- iences that have made him a tireless and widely recognized crusader for evidence- based improvements in critical care (Miller, 2002). It is difficult to imagine that evidence-based medicine, or making medical decisions on the basis of the best available credible research findings, would not lead to improved outcomes. This concept has been spreading since the early 1990s.Evidence-based medicine is the conscientious, explicit and judicious use of cur- rent best evidence in making decisions about the care of individual patients (Sackett et al., 1996, p. 71). As a board-certified healthcare architect, specialized in the design of medical environments including critical care, I have suggested that evidence-based design is an obvious analog to evidence-based medicine. Borrowing shamelessly from Sackett and his colleagues, and focusing on the analogous principles, I believe evidence-based design is the conscientious and judicious use of current best evidence, and its critical interpretation, to make sig- nificant design decisions for each unique project. These design decisions should be based on sound design hypotheses related to measurable outcomes. A decade ago I published a related description: An evidence-based designer, together with an informed client, makes decisions based on the best available information from research and project evaluations (Hamilton, 2003, p. 20). Critical deci- sions within health facility designs, based on the relevant and credible findings of research, are developed in an attempt to create environments that improve care by enhancing patient safety and by being actively therapeutic, supportive of family involvement, efficient for staff performance, and restorative for work- ers under stress. There is a clear compatibility of common themes between the design of healthcare environments based on research and the commitment to evidence-based medicine or evidence-based nursing practice in these physical settings.There is a growing body of credible research relating the environment to clini- cal outcomes. Roger Ulrich, PhD, a behavioral scientist formerly of Texas AM Craig Zimring, PhD, an environmental psychologist at the Georgia Technical Institute; and their stu- dents jointly produced a meta-analysis of the credible research (Ulrich et al., 2004), funded by The Center for Health Design and the Robert Wood Johnson Foundation. …