behavior · children · disease · environment · happiness · health

Why adult hospitals should be more like children’s hospitals – FierceHealthcare

My hospital has a goat 120/365
One hospital has a goat on their property that patients can see. One way to keep things engaging and fun and not feel like “a hospital.” (Photo credit: Jen R)

It’s not as silly as it sounds; in fact it’s genius!

Hospitals could improve patients’ quality of life, satisfaction and even health outcomes if they simply model adult hospitals after the ones designed for children, according to an opinion piece written by a fourth-year medical student in this week’s Journal of the American Medical Association.

Mark A. Attiah, who attends Perelman School of Medicine at the University of Pennsylvania in Philadelphia, writes in the piece, “Treat Me Like a Child,” that adult hospitals should take a page from pediatric facilities by creating surroundings that distract and reduce stress and making clinical practices more patient- and family-oriented rather than more convenient for caretakers.

Attiah was inspired to write the opinion piece after encounters with two pediatric patients during a rotation and another who transitioned into an adult hospital, according to an announcement about the editorial. The children’s hospital was bright, had longer visiting hours and allowed families to stay at the child’s bedside throughout the night. In addition, pediatric patients enjoyed the distractions of group activities, arts and crafts, and concerts. “If I ever get sick, I’d want to be taken here,” he writes.

more via Why adult hospitals should be more like children’s hospitals – FierceHealthcare.

Kid’s hospitals keep stuff light, upbeat, and optimistic. which is exactly what we need to get healthier, and want to go back to a particular hospital for our next ailment, since most hospitals care about that sort of thing.

brain · happiness · mental health · music

Treating the Whole Patient

Icon from Nuvola icon theme for KDE 3.x.
Treating the whole patient, including mind and body, is becoming "cool" again. Image via Wikipedia

The faculty at University of Washington is pretty progressive in a lot of its research surrounding neuroscience and the mind, especially when it comes to Mental Health Care:

Researchers and professors at the UW, such as Dr. Jürgen Unützer, are driving innovative ways to improve access to high quality mental health care delivered in a manner that treats the whole person. Their efforts are focused on health care models that integrate behavioral health services into the primary care clinic and other heath care arenas, where the patients already receive care and have established provider relationships. Known as collaborative or integrated care, these models put the patient at the center of a health team – including their physician, a care coordinator and a psychiatric consultant – that collaborates on a patient’s treatment plan.

Unützer says he knew his research into new models of mental heath care delivery was on the right track when a patient described feeling like a tennis ball. This patient had a combination of health problems associated with diabetes along with alcohol problems and depression. As is common in the current health care system, the patient was being bounced around to different specialists to treat his individual symptoms. Dr. Unützer was concerned that patients like this, with a combination of behavioral health and medical conditions, were falling through the cracks and not receiving care that treats the whole person.

“The patient expects that the various providers are all talking to each other, but that is often not the case,” he says. “Who’s connecting the dots? Patients expect their care providers to sync up and know what’s going on with all of their conditions.”

More at UW Professional & Continuing Education.

architecture · design · environment · health

Building a smoother ride to recover

A patient having his blood pressure taken by a...
Understanding environmental impacts like vibration can have a positive affect on patient recovery. Image via Wikipedia

I happened upon this tweet today:

@AIASeattle Did you know floor vibrations can affect patient outcomes?

Um, why no, no I didn’t. So I dug around a little bit and affirmed that, in fact, structural vibrations can in fact have an impact on patient recovery:

“Noticeable vibration leads many to fear structural collapse, although such fear is unwarranted in most cases because of the small displacements and stresses produced. Noticeable vibration is nevertheless undesirable in many occupancies because of its adverse psychological effect…It has been observed that continuous vertical floor oscillation becomes distinctly perceptible to people when peak acceleration reaches approximately 0.5 per cent g, where g is the acceleration due to gravity. People in residential, office and school occupancies do not like to feel distinct continuous vibration…

Continuous vibrations, defined here as vibrations lasting more than about 10 cycles, can arise from the periodic forces of machinery, from certain human activities such as dancing, or from vehicle traffic nearby. They can be considerably amplified when the periodic forces causing vibration are synchronized with a natural frequency of the structure – a phenomenon called resonance.”

Not only is shaking a problem, but there is also more and more research coming out that discusses the effects of the overall environment on a care-givers’ professional performance as well as a patient’s healing process:

“In a review of more than 600 articles, researchers found that there was a link between the physical environment (i.e., single-bed or multiple-bed patient rooms) and patient (e.g., fewer adverse events and better health care quality) and staff outcomes (e.g., reduced stress and fatigue and increased effectiveness in delivering care).

“There have been five other significant reviews of the literature relating to the physical environment and patient outcomes. Nelson and colleagues10 identified the need to reduce noise pollution and enhance factors that can shorten a patient’s length of stay (e.g., natural lighting, care in new/remodeled units, and access to music and views of nature); according to their study, patients can benefit from the skillful utilization of music and artwork. Ulrich and colleagues7 found research that demonstrated that the design of a hospital can significantly improve patient safety by decreasing health care associated infections and medical errors. They also found that facility design can have a direct impact on patient and staff satisfaction, a patient’s stress experience, and organization performance metrics. Three other reviews found that hospital design, particularly when single-bed rooms are employed, can enhance patient safety and create environments that are healthier for patients, families, and staff by preventing injury from falls, infections, and medical errors; minimizing environmental stressors associated with noise and inefficient room and unit layout; and using nature, color, light, and sound to control potential stressors.11–13

The Seattle branch of the AIA (that’s the American Institute of Architects) has hosting a talk specifically about how to design better, less drum-like floors, but is a nice indicator of how serious architects, designers, and other groups are taking this need to design and create better care facilities:

“Vibration criteria for hospital floors have become more stringent in the 2010 Edition of the Guidelines for the Design and Construction of Health Care Facilities (the FGI Guidelines). These new vibration requirements will increase structural construction costs in Healthcare construction. Understanding vibrations sources, criteria and benefits of different structural and non-structural approaches will provide healthcare designers with effective strategies to mitigate vibration issues and minimize cost impacts of the new requirements.”

For those who live in Seattle, there is a class on December 14th, 2011.

I’ve found some great examples of designing better medical facilities, but I’d love to hear about other projects you’ve seen, experienced, or even read about. Leave a comment with your thoughts.


The Fading Art Of The Physical Exam : NPR

I played sports as a kid, and always had to start my school year with a doctor’s physical exam. Apparently that doesn’t happen much anymore.

Doctors are physically examining their patients less and less, and relying more on technology. Some doctors are bucking this trend and trying to revitalize the practice of listening and actually touching their patients.

As a woman, I am still poked and prodded on a semi-regular basis (yuck!), but I’ve never had to go in for something serious, and I’ve heard others complain about this phenomenon. I’m interested what the experience of others has been.

For centuries, doctors diagnosed illness using their own senses, by poking, prodding, looking, listening. From these observations, a skilled doctor can make amazingly accurate inferences about what ails the patient.

Technology has changed that. “We’re now often doing expensive tests, where in the past a physical exam would have given you the same information,” says Jason Wasfy, a cardiologist-in-training at Massachusetts General Hospital in Boston.

As a result, many doctors are abbreviating the time-honored physical exam — or even skipping it altogether.

more at The Fading Art Of The Physical Exam : NPR.