Your Hospital Room Could Affect Outcomes After Surgery
"Location, location, location" works in real estate, and a new study argues that the location of your hospital room could save your life after surgery.
Patients are more likely to die after surgery if they are placed in certain types of rooms to recover, researchers from the University of Michigan School of Medicine found.
Specifically, the researchers said patients can expect to have a better recovery if they:
- Have a room to themselves rather than sharing with another patient.
- Are placed in a room closest to a nursing station on their floor.
- Are in a location that affords a clear line of sight from the nursing station
Just how big was the difference? People in rooms that included none of the positive features listed above were 50% more likely to die than those placed in rooms that had all the features, the research team reported.
The study was led by Dr. Andrew Ibrahim, an assistant professor of surgery, architecture and urban planning at the University of Michigan.
In the study, Ibrahim and his colleagues reviewed the blueprints for University Hospital at the University of Michigan, and graded each room to reflect design features that might influence patient outcomes.
They then used data from electronic health records to find out how well surgical patients recovered when assigned to a specific room.
Their analysis included nearly 4,000 patients who underwent one of 13 different types of high-risk surgical procedures, including kidney transplant or removal of the pancreas or colon.
Researchers were surprised to find that sicker patients already tend to be assigned to rooms with features that appear to promote better recovery, Ibrahim said.
"There's clearly some sense that the nurse managers who are assigning patients know that some rooms are better than others, because the sicker patients got rooms that had more of those features," Ibrahim said. "The sicker patients clearly were getting put in rooms that were single, close to the nursing station, with better lines of sight.
"That was very validating, because the people who are doing this work on the front line are kind of agreeing with us that all rooms are not equal," Ibrahim said.
But the association between survival odds and a room's location held up even after researchers controlled for factors such as age, the surgical procedure involved, and how sick a patient was prior to the procedure, he said.
"We still found that rooms with these features seem to have better outcomes," Ibrahim said.
A double room increased a surgical patient's risk of death during recovery by 35%, the study found, while people placed in rooms farther from a nursing station had as much as a 36% increased risk of death.
The researchers also assessed whether having a room with a window view might help patients.
Their initial analysis suggested that a window view could improve survival by 20%, but that advantage "washed out" when researchers controlled for the patient's age and health, Ibrahim said.
The findings are "very thought-provoking," said Dr. Daniel Herron, chief of general surgery at the Icahn School of Medicine at Mount Sinai in New York City.
"While we are all aware of the effect our architectural environment has on our mood and comfort, we don't typically consider that it could have an impact on our surgical outcomes," Herron said.
However, "to truly know whether the type of hospital room has an impact on mortality, it would be necessary to do a large, prospective, randomized trial, which would be a challenging endeavor," Herron added.
The results suggest that hospitals could better serve patients by assessing the layout of their building, Ibrahim said.
"In architecture, we have something called a post-occupancy evaluation," Ibrahim said. "After you build a building and it's occupied, you should evaluate how well the building performs. That gets done for less than 5% of hospitals in the United States. I think in light of our findings, it suggests maybe we should be doing this more routinely and more systematically."
Hospitals also could formally adopt the sort of patient placement strategies that apparently are already being used on an informal basis by nurse managers, Ibrahim added.
"As we get a better understanding of which rooms do better with sicker patients, we can start to right-size our patient assignment," Ibrahim said. "In the same way that we have precision medicine for this specific medicine or this specific therapy for a certain kind of patient, we probably will have some form of precision design where we can assign patients to the optimal room to give them the chance at the best recovery."
The researchers presented their findings Sunday at the American College of Surgeons annual meeting, in San Diego. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.
The Harvard Business Review has more on how hospital design can affect patient outcomes.
SOURCES: Andrew Ibrahim, MD, assistant professor, surgery, architecture and urban planning, University of Michigan, Ann Arbor; Daniel Herron, MD, chief, general surgery, Icahn School of Medicine at Mount Sinai, New York City; American College of Surgeons, annual meeting, San Diego, Oct. 16, 2022