Windows, layout and other hospital room features play a role in surgical patients' clinical outcomes, study finds

The layout and features of a surgical patient’s hospital room appear to have an impact on their clinical outcome, according to new single-center study data presented this week at the American College of Surgeons’ annual meeting.

Among a sample of nearly 4,000 University of Michigan Hospital patients, researchers found that room features such as the distance to a nursing station, single-person occupancy and a layout allowing clinicians a direct line of sight into the room all influenced clinical outcomes.

These types of rooms were also more likely to be assigned to sicker surgical patients, they noted.

“We were fascinated to see from a previous study that mortality was different in rooms that were in the line of sight of a nurse’s station,” Mitchell Mead, study co-author and a health and design scholar at the University of Michigan, said in a release. “Nurses could more readily assess the patient’s condition and intervene more quickly in severe events. We wanted to see how this finding would play out at our institution, specifically in a surgical population.”

The study reaffirmed findings from as far back as 1984, including those suggesting that patients admitted to rooms with a window view are at reduced risk of mortality.

Specifically, patients in rooms without a window recorded 20% higher mortality and 10% higher 30-day mortality rates compared to those with windows after adjustment for comorbidities and procedure complexity.

Of note, the varying mortality rates across room designs disappeared after researchers accounted for patients’ length of stay.

“This investigation provided evidence that patients had differential outcomes across room design features, when accounting for clinical risk, and warrants further investigation for how hospital design may be influencing outcomes,” Mead said.

The study included 3,964 patients who underwent 13 high-risk surgical procedures, such as colectomy or kidney transplant, who were admitted between 2016 and 2019. Researchers characterized their rooms based on features including window, occupancy, nursing station distance and clinician line of sight.

Andrew Ibrahim, M.D., study co-author and assistant professor of surgery, architecture and urban planning at the University of Michigan, said in a statement that further research into hospital design features and patient outcomes could help the industry “get a much better return on what we build.”

He acknowledged that renovations to an existing facility’s rooms reflecting the findings are “not practical” for many hospitals, but said understanding the patterns could lead to more efficient patient room assignments.

“We can start to prioritize the sickest patients there,” he said. “Just the way we have developed precision health models for getting the right care to the patient, there may be a corollary for the right room for the right patient and procedure to optimize outcomes collectively.”