Toward Healthy Underground Spaces: A Review of Underground Environmental Design Factors and Their Impacts on Users' Physiological and Psychological Health.

OBJECTIVE: This study aims to review and synthesize what design factors are associated with the physiological and psychological health of occupants in underground spaces. BACKGROUND: The development of underground spaces offers options to global challenges, such as traffic congestion, urban overcrowding, the revitalization of dormant underground areas, disaster mitigation, and adaptation to extreme environments. Despite these advantages, concerns persist about potential adverse effects on human health in these environments. This situation underlines the necessity of systematically identifying concerns and perceptions related to health in underground spaces. METHODS: A narrative literature review was conducted to examine the relationship between design factors and health factors across 21 empirical studies. Based on the review of the identified literature, a relationship diagram was developed to depict the interconnections between the identified design and health factors. RESULTS: The analysis identified design factors related to the air, sound, light, nature, transport, and spatial context of underground spaces, each of which exerted relationships with occupants' physiological and psychological health factors. The relationship diagram indicated that the psychological factor "feeling of confinement" was mentioned most frequently, suggesting that it is one of the most extensively researched factors in this context. CONCLUSIONS: The relationship diagram aims to bridge the existing knowledge gap and set the stage for future research endeavors. The ultimate goal is to refine urban living standards by leveraging the potential of underground spaces while ensuring health and well-being.

Improving the Mental Health of Surgical Teams Through Operating Room Design.

OBJECTIVE: In this study, we aim to develop and propose an evaluation method for analyzing the design of operating rooms (ORs) from the perspective of surgical teams' reported experiences and stress levels. BACKGROUND: Stress and burnout of surgical team members can lead to diminished performance and medical errors, which endangers the safety of both the patients and team members. The design and layout of the OR play a critical role in managing such stress. METHODS: To understand surgical teams' spatial needs related to their experiences and stress, we administered a survey and in-depth focus group discussions to three surgical teams from the same organization. The identified spatial needs were translated into functional scenarios and spatial metrics, essentially viewing the OR through the perspective of users. RESULTS: Our analysis revealed four integral sections-patient flow, room organization, access to facilities/medical equipment/support staff/team members, and staff well-being-identified as critical design factors associated with the experiences and stress levels of the surgical teams in the ORs. CONCLUSIONS: We expect this method to serve as a tool for evaluating the effect of the design of OR layouts on stress, thereby supporting the well-being and resiliency of surgical teams.

Placing Users at the Center: Evaluating Exam Room Design for Improved User Experience.

OBJECTIVE: This article proposes a method for evaluating the design affordances of primary care exam rooms from the perspectives of users using functional scenario (FS) analysis. GOAL: This study aims to develop quantifiable criteria and spatial metrics for evaluating how exam room design supports the needs of different users. These criteria and metrics can be used in the early stages of the design process to choose between alternatives. BACKGROUND: The primary care exam room is an essential space in healthcare, as it is the first point of contact between the healthcare provider and the patient. However, there is a lack of rigorous evaluation metrics for exam room design that supports improved user experiences and better health outcomes. METHOD: A total of nine primary care exam rooms were analyzed using FS analysis. We identified three key user groups involved in the clinical examination process-providers, patients, and care partners-and translated their needs into FSs. We developed spatial metrics for each FS to quantify the extent to which the needs were spatially supported. RESULTS: We developed 11 FSs in total: three from the providers', five from the patients', and three from the care partners' perspectives. The results revealed possible design strategies for improved user experiences. CONCLUSIONS: We quantitatively measured the affordance of primary care exam room design for multiple stakeholders. We expect that the criteria and metrics presented in this article will improve the understanding of different users' perspectives and provide new design guidance for improved user experiences.

Healthcare design to improve safe doffing of personal protective equipment for care of patients with COVID-19.

OBJECTIVE: Understand how the built environment can affect safety and efficiency outcomes during doffing of personal protective equipment (PPE) in the context of coronavirus disease 2019 (COVID-19) patient care. STUDY DESIGN: We conducted (1) field observations and surveys administered to healthcare workers (HCWs) performing PPE doffing, (2) focus groups with HCWs and infection prevention experts, and (3) a with healthcare design experts. SETTINGS: This study was conducted in 4 inpatient units treating patients with COVID-19, in 3 hospitals of a single healthcare system. PARTICIPANTS: The study included 24 nurses, 2 physicians, 1 respiratory therapist, and 2 infection preventionists. RESULTS: The doffing task sequence and the layout of doffing spaces varied considerably across sites, with field observations showing most doffing tasks occurring around the patient room door and PPE support stations. Behaviors perceived as most risky included touching contaminated items and inadequate hand hygiene. Doffing space layout and types of PPE storage and work surfaces were often associated with inadequate cleaning and improper storage of PPE. Focus groups and the design charrette provided insights on how design affording standardization, accessibility, and flexibility can support PPE doffing safety and efficiency in this context. CONCLUSIONS: There is a need to define, organize and standardize PPE doffing spaces in healthcare settings and to understand the environmental implications of COVID-19-specific issues related to supply shortage and staff workload. Low-effort and low-cost design adaptations of the layout and design of PPE doffing spaces may improve HCW safety and efficiency in existing healthcare facilities.