Why adult hospitals should be more like children's hospitals

Hospitals could improve patients' quality of life, satisfaction and even health outcomes if they simply model adult hospitals after the ones designed for children, according to an opinion piece written by a fourth-year medical student in this week's Journal of the American Medical Association.

Mark A. Attiah, who attends Perelman School of Medicine at the University of Pennsylvania in Philadelphia, writes in the piece, "Treat Me Like a Child," that adult hospitals should take a page from pediatric facilities by creating surroundings that distract and reduce stress and making clinical practices more patient- and family-oriented rather than more convenient for caretakers.

Attiah was inspired to write the opinion piece after encounters with two pediatric patients during a rotation and another who transitioned into an adult hospital, according to an announcement about the editorial. The children's hospital was bright, had longer visiting hours and allowed families to stay at the child's bedside throughout the night. In addition, pediatric patients enjoyed the distractions of group activities, arts and crafts, and concerts. "If I ever get sick, I'd want to be taken here," he writes.

There is strong data that shows better patient environments can improve outcomes, the piece notes.

Attiah realized the importance of the patient's environment when he met a patient who became an adult overnight, by turning from age 17 to 18. Moved out of the children's ward, she no longer had access to art, games or the privileges of having a family member around at any time. Instead, she could only lie around and dwell on her illness.

But Attiah noted it isn't only the patient's surroundings that changed. The approach to care is different as well. What troubled this new adult patient the most, he writes, was the actual medical team. "They weren't as happy to be there," she said, recounting how she had to defend her need for pain medications against the suspicions of physicians all too familiar with drug seekers.

"There's an assumption that adult patients have developed a certain hardiness, a stiff upper lip that renders a reasonably pleasant environment or even sometimes a complete patient-physician trust unnecessary," he argues. Physicians approach adult patients as seasoned veterans who are able to cope with the hardships of being ill in an alien environment with relative ease, even though this is often untrue.

"The truth is that without help, most people, regardless of their age, aren't naturally good at being patients," he writes.

In addition, he notes at a children's hospital, families are almost always involved in codes (emergency procedures) and even call codes themselves--unheard of in most adult hospitals. The change in attitude implied that patients' families are not equal parts of the healthcare team and that the physician's comfort is more important than the peace of mind of concerned family members. However, Attiah notes a multicenter trial found that families present during codes don't increase lawsuits or interfere with medical efforts.

"This is not a call to place a large teddy bear in every hospital bed and a bounce house in every lobby," Attiah concludes. "We do, however, need to recognize that the environment, the practice patterns, and the mission of a hospital make a direct difference in patient care that can be measured not only in smiles and thank-you notes, but tangible patient outcomes that even hospital administrators can get behind."

To learn more:
- read the editorial
- here's the announcement
- check out the study