El hospital del futuro en 10 puntos / The hospital of the future in 10 points

La Sociedad Española de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals

Efficacy of Medical Operations and Layout Planning Onboard Nontraditional US Navy Vessels at High Seas.

INTRODUCTION: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures. METHODS: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California. The ability of personnel to perform these procedures was quantified by the use of motion link analysis designed to track the movement of each participant as they completed their assigned tasks. RESULTS: The link analysis showed no significant change in the number of movements of participants from the beginning to the end of the study. However, there was a learning effect observed during the study, with teams completing tasks faster at the end of the study than at the beginning. CONCLUSION: This shows that the working conditions aboard the US Naval Ship Brunswick were satisfactory for the assigned tasks, indicating that these medical operations may be feasible aboard nontraditional US Navy vessels.

Healing architecture and psychiatric practice: (re)ordering work and space in an in-patient ward in Denmark.

Healing architecture is a defining feature of contemporary hospital design in many parts of the world, with psychiatric in-patient facilities in Denmark at the forefront of this innovation. The approach rests on the contention that designed clinical spaces and the particular dispositions they express may promote patient recovery. Although the idea that health may be spatially mediated is well-established, the means of this mediation are far from settled. This article contributes to this debate by analysing medical encounters in the context of a new purpose-built psychiatric hospital opened in Slagelse, Denmark in late 2015 as an example of healing architecture for the region. Grounded in qualitative research conducted in two wards between 2016 and 2017, we explore the key material and social effects of the hospital's healing architecture, and the spaces and practices it enacts. Following the work of Michael Lynch, we consider both the designed 'spatial order' of the in-patient wards and the 'spatial orderings' unfolding therein with a particular interest in how order is accomplished in psychiatric work. With much of the existing discussion of healing architectures focusing on their impacts on patient wellbeing, we consider how healing architectures may also be transforming psychiatric work.

Anticipated advantages and disadvantages of a move to 100% single-room hospital in Australia: A case study.

OBJECTIVES: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. METHODS: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. RESULTS: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction. CONCLUSION: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.

Decentralization: The Corridor Is the Problem, Not the Alcove.

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.

Single room versus open-bay design in neonatal intensive care units for improvement in infant outcomes: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the impact of single room neonatal intensive care unit (NICU) design on infant outcomes compared to alternative design.The specific question is: what is the impact of single room design on outcomes of infants cared for in intensive care units compared to those in alternative designs?

Building Research Infrastructure in Magnet® Hospitals: Current Status and Future Directions.

OBJECTIVE: The aim of this study was to describe the infrastructures supporting research in Magnet® hospitals. BACKGROUND: Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructures that support the infusion of research and EBP into clinical practice. METHODS: An electronic survey was developed and distributed to the chief nursing officer or Magnet coordinator of all Magnet hospitals between June 10, 2015, and July 8, 2015. RESULTS: Of the 418 Magnet hospitals invited, 249 responses (60%) were received. Resources dedicated to nursing research were difficult to isolate from those for EBP. Supporting clinical nurses' time away from the bedside remains a challenge. Nearly half (44%) indicated that research is conducted within the nurses' usual clinical hours, and 40% indicated that nurses participate on their own time. CONCLUSIONS: Hospitals use a variety of resources and mentor arrangements to support research and EBP, often the same resources. More targeted resources are needed to fully integrate research into clinical practice.

Designing cancer centres' many challenges.

Catherine Zeliotis, healthcare leader and senior associate at global healthcare architectural practice, Stantec (pictured), discusses the latest thinking in the design of cancer centres, providing best practice examples from Stantec projects throughout the world.

Planning, Designing, Building, and Moving a Large Volume Maternity Service to a New Labor and Birth Unit: Commentary and Experiences of Experts.

Three teams of perinatal expert nurses participated in planning and designing a new maternity unit, operationalizing the move to the new space, and evaluating care processes and workflows after the move. The hospitals involved were University of California, San Francisco Benioff Children's Hospital, Prentice Women's Hospital of Northwestern Memorial Healthcare in Chicago, IL, and Florida Hospital Orlando, Florida Hospital for Women. Although each team discussed specific details and lessons learned, there is remarkable consistency among the experiences of these teams and with the discussion of the process by the team at Mercy Hospital St. Louis published in this issue of MCN The American Journal of Maternal Child Nursing. Extensive planning, flexibility, involving key stakeholders, evaluating and simulating workflows, and adequate staffing and patient safety on move-day were reported to be essential to success. Reevaluation after settling in to the new unit and making changes as needed were discussed. Being part of the leadership team involved in planning and moving to a new maternity unit in what was likely a once-in-a-lifetime experience was viewed as a career highlight. Their commentary adds to what is known about planning and designing new maternity units, moving into the new space, and adjusting unit operations and care after making the new unit home.

Mounting evidence favoring single-family room neonatal intensive care.

Controversy regarding the optimal design for neonatal intensive care has existed for more than 20 years. Recent evidence confirms that in comparison with the traditional open-bay design, the single-room facility provides for improved control of excessive noise and light, improved staff and parental satisfaction with care and equal, or possibly reduced, cost of care. Single-room care was not associated with any increase in adverse outcomes. To optimize long term developmental outcomes, single-room care must be augmented with appropriate developmental therapy and programs to actively support parental involvement.