Building the Evidence Base for Evidence-Based Design

Abstract

Editors' IntroductionT he United States is starting one of the largest health care construction programs in its history.A "perfect storm" of aging baby-boomers, higher health care utilization by younger people, movement to the suburbs and Sunbelt, competitive pressures to replace hospitals with semiprivate rooms, and the need to replace antiquated 1960s-era Hill-Burton hospitals has led to a health care building boom.Eighty-six percent of U.S. hospitals intend to build a new building in the next 2 to 5 years, according to a 2006 random survey of hospital CEOs by Harris Interactive (Morrison, May 30, 2006, personal communication).Healthcare construction is expected to exceed $76 billion a year by 2011 and continue at a high level to 2020 and beyond (FMI, 2006).At the same time, it is becoming clear that health care is unnecessarily dangerous and stressful.According to the Institute of Medicine's "quality chasm" reports, as many as 98,000 people die of preventable medical errors each year and 88,000 die of hospital-acquired infection (Institute of Medicine, 2004).This is made worse by a 20% annual turnover rate of hospital-based nurses, the first line of defense for patient safety and for health care quality.When nurses leave, hospitals are often losing their most experienced clinicians (Institute of Medicine, 2004).A growing body of research is demonstrating that improved physical design can help bring about dramatic increases in safety and quality-particularly reductions in infection, falls, errors, transfers, nurse turnover and stress, and increases in satisfaction (Ulrich, Zimring, Quan, & Joseph, 2006; Zimring, Ulrich, Joseph, & Quan, 2006).This has led to increased interest in using evidence-based design-design that is informed by a deep knowledge of research and a commitment to add to that knowledge base through careful evaluation and information sharing (Hamilton, 2003(Hamilton, , 2004)).Evidence-based design is modeled on evidence-based medicine, where clinical protocols are based on systematic reviews of the research literature that evaluate the quality and quantity of research supporting the efficacy of specific clinical decisions.For example, evidence-based design has led the American Institute of Architects to require that new acute care hospitals include only single rooms in their 2006 Guidelines for the Design and Construction of Health Care

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