Back to basics: Practical strategies to reduce sensory overstimulation in the emergency department identified by adults and caregivers of children with autism spectrum disorder.

INTRODUCTION: Sensory overstimulation of autistic patients of all ages during an ED visit can ultimately lead to care escalation, but few studies have evaluated patient perspectives on improving the ED sensory experience across the age continuum. The purpose of this study was to explore patient-centered perspectives on reducing adult and pediatric autistic patients' sensory stimulation during an ED visit. METHODS: We used a qualitative descriptive design to explore how autistic patients experience sensory disruption and recommendations to improve care. Data were analyzed inductively using an overall categorization of 6 senses (visual, auditory, touch, smell, taste, and proprioception). RESULTS: Fourteen adults and 30 caregivers of children provided written responses to open-ended interview questions (n = 44). Participants suggested strategies to minimize the sensory disruption they experienced; however, an overarching recommendation was for clinicians to ask about their or their child's preferences before delivering care or services. CONCLUSION: Because people with autism are more likely to visit an ED than their neurotypical counterparts, ED clinicians should be proficient in "sensory-friendly care." A variety of evidence-based practical strategies and design approaches exist that can be leveraged to reduce the risk of care escalation; however, the most basic may be to prioritize asking patients and their caregivers about their preferences prior to providing care.

Clinical outcomes of ventricular assist device support by HIV infection status: An STS-INTERMACS analysis.

BACKGROUND: Cardiovascular disease remains the leading cause of mortality in human immunodeficiency virus-infected (HIV-positive) patients. Ventricular assist device therapy is rarely offered to these patients and data on outcomes are sparse. We investigated outcomes following ventricular assist device implants for HIV-positive as compared to non-HIV-infected (HIV-negative) patients. METHODS: We analyzed 22,065 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry for outcomes by HIV status. A propensity-matched analysis adjusting for 21 preimplant risk factors was also conducted. RESULTS: Compared with 21,980 HIV-negative device recipients, the 85 HIV-positive recipients were younger (median age 58 years vs 59 years, p = 0.02), had lower body mass index (26 kg/m2 vs 29 kg/m2, p = 0.001), and had higher rates of prior stroke (8% vs 4%, p = 0.02). In the matched HIV-positive and HIV-negative cohorts, there was significantly higher mortality in HIV-positive patients in earlier implant years, however, this association was not seen in later implant years (2018-2020). In both unmatched and matched cohorts, no significant differences in postimplantation stroke, major bleeding, or major infection were noted. CONCLUSIONS: With recent advancements in mechanical circulatory support and HIV treatment, ventricular assist device therapy is a viable therapeutic option for HIV-positive patients with end-stage heart failure.

Evidence-Based Strategies in Using Persuasive Interventions to Optimize Antimicrobial Use in Healthcare: a Narrative Review.

A rise in antimicrobial resistance, seen especially since 2000, is in part caused by indiscriminate antimicrobial use. Varied types of persuasive interventions aimed to optimize antimicrobial use have been tried with varying success. Our review seeks to identify and assess factors associated with the successful implementation of persuasive interventions. We searched five databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, and ERIC) to identify critical studies published between 2000 and December 2018 of interventions employing audit and feedback, education through meetings, academic detailing, reminders, and patient, family, or public education. Outcome measures of interest were any means to measure antimicrobial use. We included 26 articles in our analysis. Seventeen examined multimodal interventions and the most common was audit and feedback and meeting (four studies). Nine examined single interventions and the most common was audit and feedback (five studies). Our findings inform four evidence-based strategies to enable healthcare administrators, clinicians, and researchers to make informed choices when planning and designing an antimicrobial stewardship program: (1) implement a combination of persuasive interventions from both groups: audit and feedback, academic detailing, or patient, family, or provider education; and meeting or reminders, (2) design interventions that last one year or longer; post-intervention, assess the intervention's long-term effects for at least another one year, (3) conduct quality improvement projects examining persuasive interventions if the prescribing database provides adequate diagnosis information, and most importantly, (4) make patient, family, or provider education an integral component of multimodal intervention.

The Impact of Green Space on Violent Crime in Urban Environments: An Evidence Synthesis.

Can the presence of green space in urban environments reduce the frequency of violent crime? To ascertain the evidence on this topic, we conducted an in-depth literature review using the PRISMA checklist. The search parameters included US articles written in English and published since 2000. More than 30,000 potential paper titles were identified and ultimately, 45 papers were selected for inclusion. Green spaces typically comprised tree cover, parks and ground cover. Criminal behaviors typically included murder, assault, and theft. The majority of the research reviewed involved quantitative methods (e.g., comparison of green space area to crime data). We extracted multiple mechanisms from the literature that may account for the impact of green space on crime including social interaction and recreation, community perception, biophilic stress reduction, climate modulation, and spaces expressing territorial definition. Recommendations are made for future research, such as meta-analysis of existing data and the development of grounded theory through qualitative data-gathering methods. By providing evidence that access to nature has a mitigating impact on violence in urban settings, city governments and communities are empowered to support these interventions.

Probabilistic Return-on-Investment Analysis of Single-Family Versus Open-Bay Rooms in Neonatal Intensive Care Units-Synthesis and Evaluation of Early Evidence on Nosocomial Infections, Length of Stay, and Direct Cost of Care.

BACKGROUND:: There is increasing evidence that the physical environment of neonatal intensive care units (NICUs), including single-family rooms (SFRs) versus open-bay rooms (OPBYs), has tangible effects on vulnerable patients. The objective of this study was to illustrate the financial implications of SFR versus OPBY units by synthesizing and evaluating the evidence regarding the benefits and costs of each unit from a hospital perspective. METHODS:: We assumed a hypothetical NICU with 40 beds in OPBY rooms, to be replaced with a new NICU with 32 SFRs and 8 OPBYs. We synthesized evidence regarding the comparative benefit of each option on 3 outcomes-nosocomial infections, length of stay, and direct costs. We calculated incremental benefit-cost ratio separately considering each outcome over an analysis period of 5 years. A ratio of more than 1 indicates that the investment is worthwhile. Input parameters were assigned probability distributions representing the degree of uncertainty around their true values. Monte Carlo simulation with 5000 iterations was used to quantify the distribution of benefits and costs. RESULTS:: The mean value of the incremental benefit-cost ratio was 0.730 (95% credible interval: 0.724-0.735) when nosocomial infections were considered, 1.298 (1.282-1.315) when reduced length of stay was considered, and 1.794 (1.783-1.804) when direct costs of care were compared. The probability of a benefit-cost ratio of lower than 1 was about 91%, 31%, and 2% in each case, respectively. CONCLUSION:: Cost savings associated with SFR units would justify additional construction and operation costs compared to OPBY units only when evidence on inclusive outcomes such as length of stay or direct costs of care is considered. A specific outcome such as infection rate potentially fails to capture all benefits of SFRs. As more evidence becomes available on full benefits and hazards of SFRs versus OPBYs, future studies should investigate the broader return-on-investment outcomes.

Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives.

This ethnographic study draws on the experiences of members of interdisciplinary care teams working with end-of-life care patients to identify strategies to improve quality of life through care practices. We surveyed 133 staff and volunteers (physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators, and volunteers) who provide end-of-life care to patients in both home and institutional settings for 4 organizations in 2 counties in Upstate New York. Survey responses were analyzed using qualitative content analysis. The results identified numerous strategies to enhance and safeguard quality of life for end-of-life care patients and their family members. These strategies can be categorized into 6 domains: organization philosophy and mission; organizational policies; caregivers' behaviors and practices; symptom management; facility design, operation and management; and patient, family member, and caregiver experience. The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers, and support staff. When all of these strategies are used in harmony, care can truly be enhanced.

Alert Workplace From Healthcare Workers' Perspective: Behavioral and Environmental Strategies to Improve Vigilance and Alertness in Healthcare Settings.

OBJECTIVE: This study aims to identify the behavioral and environmental strategies that healthcare workers view as helpful for managing sleepiness, improving alertness, and therefore optimizing workplace safety. BACKGROUND: Reduced alertness is a common issue in healthcare work environments and is associated with impaired cognitive performance and decision-making ability as well as increased errors and injuries. METHOD: We surveyed 136 healthcare professionals at a primary care clinic, an acute care hospital, and a mental health clinic. Nonstructured, semistructured, and structured questionnaires were used to elicit relevant information which was analyzed using qualitative content analysis and logistic regression models, respectively. RESULTS: In order by frequency of endorsement: dietary intervention; physical mobility; cognitive, sensory, or social stimulation; personal lifestyle strategies; and rest/nap opportunities were reported as behavioral strategies used to address workplace alertness. Compared to other environmental features, daylight and thermal comfort were perceived to be more important to addressing workplace alertness ( p < .05). CONCLUSIONS: By optimizing the physical environment and organizational policies and providing education programs, we have an opportunity to support healthcare professionals in managing sleepiness and maintaining alertness at work. In addition, such system level interventions may reduce unhealthy choices such as frequent caffeine intake to keep alert. The development of multidisciplinary evidence-based guidelines is needed to address sleepiness and alertness to improve workplace safety in healthcare facilities.

Do cost savings from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study.

PURPOSE: Evidence shows that single-patient rooms can play an important role in preventing cross-transmission and reducing nosocomial infections in intensive care units (ICUs). This case study investigated whether cost savings from reductions in nosocomial infections justify the additional construction and operation costs of single-bed rooms in ICUs. MATERIALS AND METHODS: We conducted deterministic and probabilistic return-on-investment analyses of converting the space occupied by open-bay rooms to single-bed rooms in an exemplary ICU. We used the findings of a study of an actual ICU in which the association between the locations of patients in single-bed vs open-bay rooms with infection risk was evaluated. RESULTS: Despite uncertainty in the estimates of costs, infection risks, and length of stay, the cost savings from the reduction of nosocomial infections in single-bed rooms in this case substantially outweighed additional construction and operation expenses. The mean value of internal rate of return over a 5-year analysis period was 56.18% (95% credible interval, 55.34%-57.02%). CONCLUSIONS: This case study shows that although single-patient rooms are more costly to build and operate, they can result in substantial savings compared with open-bay rooms by avoiding costs associated with nosocomial infections.

Physical Work Environment as a Managerial Tool for Decreasing Job-Related Anxiety and Improving Employee-Employer Relations.

The expected increase in healthcare needs resulting from the Affordable Care Act and the growing population of older citizens in the United States is challenging owners and operators of hospitals to improve quality of care and reduce operational costs. Meanwhile, studies have indicated a serious shortage in the healthcare workforce and have highlighted the critical role of employees' job-related attitudes and feelings. The main objective of this study was to test whether employees' evaluations of important environments within hospitals were significantly associated with their job-related attitudes and feelings, and whether this relationship varied across different demographic groups. About 700 healthcare professionals from 10 acute-care hospitals run by three healthcare organizations participated in this cross-sectional study. Structural equation modeling found that employees' evaluations of their physical work environment were significantly associated with lower rates of job-related anxiety, higher levels of job satisfaction, and increased rates of organizational commitment. Perceived organizational support was responsible for mediating part of these relationships, indicating that employees can perceive a healthy work environment as a sign of their organization valuing them and caring about their well-being. When distinguishing between different spaces, analysis found that satisfaction with rest areas and work spaces had the largest effect size, while the influence of patient areas was small. Employees newer to the facility and to the organization were more influenced by the physical work environment. This study provides preliminary evidence that facility design can be used as a managerial tool for improving employees' job-related attitudes and feelings and earning their commitment.

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

OBJECTIVE: This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. BACKGROUND: Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. METHOD: To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. RESULTS: In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. CONCLUSIONS: Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.

The influence of facility design and human resource management on health care professionals.

BACKGROUND: Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. PURPOSE: The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. METHODOLOGY: About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. FINDINGS: The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. PRACTICE IMPLICATIONS: Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.

Corporate sustainability: the environmental design and human resource management interface in healthcare settings.

UNLABELLED: Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions. BACKGROUND: This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework. THEORETICAL FRAMEWORK: The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs. CONCLUSIONS: Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms. KEYWORDS: Staff, evidence-based design, interdisciplinary, modeling, perceived organizational supportPreferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sustainability: The environmental design and human resource management interface in healthcare settings. Health Environments Research & Design Journal 6(2), pp 98-118.