How Environment and Technology Can Improve Health Care

Improving patients' comfort and surroundings is one of the more obvious, consumer-friendly ways that a growing group of hospitals are retooling for the 21st century. Presented with data from countless studies showing that the physical environment affects outcomes, not to mention an explosion of high-tech innovations from "smart" beds to wearable devices that measure vital signs, these medical centers are aiming to deliver care that is safer, more effective, potentially less costly and a better customer experience.

Fixing medicine's worrying safety record (some 180,000 deaths each year are caused by medical errors, injuries or avoidable complications) requires more than changing procedures, experts have realized. The hospital itself has to change. Hundreds of decisions go into designing and outfitting these facilities, and "each one should make it easier to do the right thing for patients and harder to do the wrong thing. An early adopter of so-called evidence-based design, Virginia Mason Medical Center, in Seattle, focused closely on patient comfort and safety when it made over its cancer center, orthopedic unit and emergency department. Architects reconfigured the orthopedic unit to have parallel corridors, one for patients who may be taking their first tentative steps after knee surgery, the second for all other traffic. A new critical care unit will open next year with an imaging suite inside, so vulnerable patients don't have to leave the unit to get a scan. Not only is that much safer for patients, who may be on ventilators, but also it saves nurses' time. "We realized we were losing 14 hours of nursing care per week to travel with patients to get scans," says Deborah Cutchin, a specialist in the hospital's office of process improvement.

Building from scratch lets hospitals realize even grander visions. Rush University Medical Center in Chicago opened in its new butterfly-shaped incarnation in January 2012. Besides adding drama to the city's skyline, the design is intended to play a healing role, affording every room an expansive view; exposure to natural light and inviting landscapes has been linked to faster recovery and less need for pain medicine. Rather than sit at a central station, nurses keep an eye on their charges from small satellite work stations that offer a clear line of sight into several rooms at once. The building also contains the nation's first bioterrorism preparedness facility. In the event of a biological, chemical or radiological crisis, the ambulance bay converts into a decontamination area and panels hidden in the lobby's pillars provide access to oxygen and other gases and electrical lines. At the same time, leading-edge hospitals are rapidly getting wired. The goal: so-called ubiquitous computing, the continuous flow of data from medical equipment and apps, plus the ability to make sense of it all to improve care. Hospitals are already using sensors that alert nurses that a patient at risk of a fall is getting out of a bed, technology that monitors whether doctors and nurses are washing their hands, and flat screen TVs that ask you to rate your pain and then notify the nurse if you're really hurting.

Key to the computing stream are robust electronic health records (EHR), which have evolved from tools for billing into troves of information – such as patients' allergies and the results of their last colonoscopy – that help doctors "connect the dots" and patients avoid repeated tests and unnecessary exposure to radiation, says Rasu Shrestha, vice president of medical information technology at the University of Pittsburgh Medical Center. The proportion of hospitals with an EHR system has grown from 9 to 80 percent since 2008, according to the U.S. Department of Health and Human Services. "My own hospital is essentially paperless," says Robert Wachter, chief of hospital medicine at the University of California, San Francisco Medical Center, and a leading hospital safety expert. "All documentation – medical history, pathologist's reports, doctors' and nurses' notes – is in the system."