To decrease falls, showers have no "curb" to trip over, and hand bars circle the bathroom. Hydraulic lifts built into the ceiling can be used to move heavier patients to and from the bathroom, reducing the risk of injury to both patient and caregivers. Other popular trends: putting monitors and access to oxygen and outlets into headwalls so a standard room can convert to critical care, and using curtains, floor coverings and finishes engineered to resist bacteria.
These features aren't cheap. According to research by a team of health care leaders and architects led by Sadler, 16 of the most solid evidence-based design measures, from high-tech surveillance systems in the ICU to highly filtered air, add 7 percent to a typical construction budget. But the features pay for themselves with fewer injuries and errors and shorter stays within three years. Says Sadler: "These ideas are game changers."
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."
A growing array of smart devices is feeding the flow of data and cracking down on safety hazards. Palomar patients wear ViSi Mobile System wrist devices that constantly measure their vitals and wirelessly transmit the data to the EHR, eliminating the need to enter the data or to wake the patient for a 2 a.m. blood pressure reading. Manufacturers are rolling out beds that weigh and turn over patients and pivot slightly from hour to hour to redistribute their weight, reducing the risk of pressure sores. Radiofrequency identification tags on ID badges and on room sinks monitor hand-washing habits. Thanks to chips embedded in surgical instruments and sponges, surgeons can wave a wand over their patient before sewing him up to locate anything that might be left inside.
With flat screen monitors offering the Internet and entertainment and easy ordering of meals and snacks using a remote control device, the modern hospital room may sound more like a five-star hotel suite. Such amenities undoubtedly attract customers and nudge up the price tag. But room monitors perform other useful duties, too. When providers at the University of Pittsburgh Medical Center stop in on a patient equipped with SmartRoom, an ultrasound tag on their ID badges brings their name and role up on the TV screen and can pull up the patient's EHR. Patients can play games, receive email and find out about an upcoming test.