Trends in ED and Inpatient Services

In March, an interesting article was published examining the trends in the supply of beds in California’s emergency departments in relation to those in inpatient services. This retrospective analysis reviews the supply and demand of beds from 2005 – 2014. It addresses several factors contributing to the ebb and flow of bed availability across the state and presents a new methodology for analyzing trends. The new metric – ‘beds per visit’ –  suggests the State of California has an inadequate supply of ED and specific inpatient beds.

While this study looks only at the State of California, the issue of ED overcrowding continues to plague hospitals across the United States. We are interested in better understanding this phenomenon and how the hospitals in which we work strive to manage this symbiotic relationship between emergency departments and inpatient services.

The 3P Workshop

In architecture school students are introduced to Louis Sullivan’s modernist mantra ‘form follows function’. This mantra follows a strict two-step chronology:

  • First, the function of the space is defined, vetted and communicated. Here the needs of the client and the space are outlined. Traditionally, this step is completed by the client with or without outside consultants.
  • In step two, designers are invited to explore the form or how the established function is spatially organized.

While this two-step process is widely accepted as the logical progression of a design, today many architects are being invited into the first step: defining function.

Often, our clients come to us questioning the needs and processes of a facility or department. The hospital has an interest in exploring a change of function, but the new requirements have not yet been defined. For example, we are often asked to examine metrics collected by a hospital and translate patient population projections into spatial requirements. Other times, when a department is interested in exploring a new treatment methodology, we are asked to explore the consequential spatial impact. We appreciate these requests as they seek to engage us in the entire process of defining both the form and the function.

To further provide services in line with our clients’ growing needs, several of our architects and designers have been trained in Lean and Six Sigma strategies. Lean is a process designed to reduce waste and increase efficiencies. Its principles and tools have been widely embraced by the business and planning professionals within the healthcare industry.

One Lean exercise we have found particularly useful is the 3P (Production Preparation Process) event. In these three to five day events both the process (function) and design (form) of a facility are carefully examined. The event is unique in its inclusion of all key stakeholders and users. It is not just healthcare executives making decisions regarding the future state of care delivery, but also physicians, nurses, support staff and patients. At each event current and future state flows are outlined and design solutions vetted across disciplines.

Our Lean Design Team recently hosted a 3P event for Lifespan Health System in Newport, RI. Across three days, more than 70 attendees informed the schematic design of a new 13,100 SF Emergency Department at Newport Hospital. The facility incorporated state-of-the-art strategies for emergency care, increases the number of treatment bays, expand triage capacity, expand waiting room and entrance space, and host a dedicated Rapid Treatment Area, Clinical Observation Unit, and Behavioral Health Suite.

Promising New Treatment for Sepsis

Sepsis is a life-threatening condition associated with an inflammatory response to infection that has the potential to cause multiple organ failure. Sepsis kills more people in the hospital than any other disease. Worldwide, Sepsis is estimated to impact 15 to 19 million people annually with a mortality rate approaching 60% in low income countries.

Many people in the scientific and medical communities are hoping that the findings of Dr. Paul Marik in the Journal Chest will revolutionize the treatment of Sepsis. Dr. Marik, working from preliminary research findings by Dr. Berry Fowler and his colleagues at the Virginia Commonwealth University (VCU) in Richmond, began treating septic patients with an intravenous cocktail of vitamin C, low dose of corticosteroids, and thiamine (another vitamin).

After Dr. Marik treated 50 patients, he submitted his results to Chest. Of 47 patients treated with the vitamin C cocktail, only four died in the hospital. Of the four deaths, all were from their underlying diseases – not from sepsis. For a control, Dr. Marik looked back at 47 septic patients treated previously in his hospital without vitamin C infusion and found that 19 had died. While the data is still suggestive, the outlook is promising.

Dr. Fowler and his laboratory at VCU was recently awarded a $3.2 million grant from the NIH to run a controlled study to examine the use of vitamin C to treat sepsis. The study will be conducted at several universities and be double-blinded (information about the test kept from the testers and participants) as to limit bias, both intentional or unconscious.

We are excited about the potential of this research and the tremendous potential this will have on both patients and the healthcare industry.

We learned of the success and studies from NPR, in their article Doctor Turns Up Possible Treatment for Deadly Sepsis.

Breakthrough in Autism Research

An exciting breakthrough in autism research was recently published in the highly reputable academic journal, Nature. Scientists have observed brain enlargement in children with autism spectrum disorder (ASD). A retrospective analysis of head circumference and longitudinal brain volume studies in two to four-year-olds indicate increased brain volume may be an early indicator of ASD. These findings suggest an earlier diagnosis may be possible, helping those with ASD and their caregivers better respond to challenges associated with the disorder.

In any given year, 1 in 68 Americans is diagnosed as having autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Jacques Black, AIA, a partner in our New York City office, has completed several projects for the Center for Autism and the Developing Brain in White Plains, NY. Together with Cathy Lord, a clinical psychologist and director of the Center for Autism and the Developing Brain, he has published and presented on the unique dynamics of the built environment and individuals with ASD.  For example, when designing for autistic patients it is important to acknowledge and address their sensitivities to noise, color, and texture.

We are excited about the potential this research has for young families across the world and will continue to seek to better understand how to design spaces which address the unique needs of patients with ASD.

Cancer Death Rates Fall

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E4H was elated to read the number of deaths from cancer in the United States have dropped 25 percent since hitting a peak in 1991. The report, issued by the American Cancer Society, hit home for a lot of us.

This drop means that 2.1 million fewer people died from cancer between 1991 and 2014 than would have died if cancer death rates had remained at their 1991 level, the researchers said. As mothers, fathers, sisters, brothers and children, we appreciate what a big deal this is for families across the world.

The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer’s deadly toll,” Dr. Otis Brawley, the chief medical officer of the American Cancer Society, said in a statement. “Continuing that success will require more clinical and basic research to improve early detection and treatment, as well as strategies to increase healthy behaviors nationwide.”

We are proud of our work with both healthcare providers and researchers who work to fight the many forms of this disease.

This story was originally reported in LiveScience

 

Tracking Cancer

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New research out in American Chemical Society (ACS) Nano suggests the approach to tracking cancers may be on the verge of revolution. Liposomes, tiny fatty envelopes, are often used to package anti-cancer drugs as they tend to congregate around loosely bound tumor cells as a matter of biophysics.

Rafael de Rosales of King’s College, London, and Alberto Gabizon of the Shaare Zedek Medical Centre in Jerusalem have treated mice with liposomes doped with radioactive metal ions and shown the special liposomes congregate around an animals’ tumor. What is special about this finding is that these supped up liposomes are visible by positron-emission tomogoraphy (PET) scanning and therefore assist physicians in following the course of drugs.

This new discovery has the potential to assist physicians in better understanding how to target cancers with missile like efficiency. The Economist published an article on this research originally published by ACS Nano.

We are excited by the progress being made in laboratories around the world to fight cancer. We feel privileged to be able to support institutions in making such remarkable strides in life sciences.

Policies on Aging

Gables at East Mountain
Gables at East Mountain

An interesting article on Elder Rights in China was published in this month’s issue of The Journal of The American Medical Association (JAMA) Internal Medicine. Author XinQi Dong, MD, MPH outlined the policies being enacted by the Chinese government to combat changing demographics and cultural expectations for filial duty.

Historically, Chinese families have seen filial piety as the highest of virtues in accordance with the treatise Classic of Filial Piety outlined by Confucius in the 4th century BC. However, these beliefs are being challenged by the Chinese people. In a recent survey by the Center for Strategic and International Studies on East Asian retirement practices only 4% of Chinese respondents believed children or family members should be responsible for proving support to older adults – the lowest percentage of all six Asian countries surveyed.

Although the One Child Policy restricting family size from 1980 to 2015 was repealed, the unintended consequence to demographics is palpable for many young workers. The realities of one working adult expected to support four grandparents and two parents are often overwhelming. Additionally, with the increase of industry around the country, many younger people are moving away from their homesteads in search of economic opportunity.

The disconnection between historical familial expectations and existing practices has forced the Chinese government to look for policy solutions to protect and support its 123 million residents (9% of the population) over 65.  In May of 2016 the Shanghai Ministry of Civil Affairs Bureau, a governmental agency ruling the largest city in China, implemented a new policy to protect older adults and shame children into supporting their families. Children found to lack devotion to their parents are placed on a ‘credit blacklist’, a tool used by the government to prevent individuals from activities such as opening a bank account, purchasing a home, or starting a business.

Dr. Dong, a professor at The Rush University Medical Center Institute for Healthy Aging, brings up an interesting and sensitive topic for many people across the globe – how do we care for our aging family members?

It is an honor to be a part of these discussions within our communities as we design senior living facilities that address the holistic needs of residents, their families and the community. Although we are far from any universal solution, it is encouraging to participate in the ongoing dialogue regarding aging with dignity and care.

New Bone Regeneration Study

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The Shah Tissue Engineering and Additive Manufacturing (TEAM) Lab recently published an article in Science Translational Medicine describing their breakthrough in bone regeneration engineering.

Shah’s lab bioengineered a new hyperelastic “bone” material that is cheap, versatile and easy to print. This invention has the potential to revolutionize the repair or regeneration of bones.

Interestingly, when TEAM placed human bone marrow stem cells on a sample of hyperelastic “bone,” its presence was enough to stimulate them to mature into bone cells. The new material served as a scaffold for the cells to form their own natural materials.

Popular Science originally reported on this breakthrough. In the article they quote coauthor Ramille Shah of Northwestern University,“I think ideally it would be great if we could have these printers in a hospital setting where we can provide them the hyperelastic ‘bone’ ink and then they can then make patient specific implants that day—within 24 hours,” Shah said.

This new material has tremendous potential to revolutionize the way bone injuries are treated in the future. We are excited by the thoughtful and applicable research coming out of higher education.

 

Forbes report on Healthcare and Technology

http://www.forbes.com/healthcare-2025/#40f986664f30
http://www.forbes.com/healthcare-2025/#40f986664f30

Forbes recently published a report on how technology is revolutionizing the healthcare industry. It looks at three categories: Consumers and technology, Funding and Finance and Active Lifestyles.

The report references a StartUp Health Insights report that stated digital heath companies received a record $1.8 billion dollars in funding in the first quarter of 2016 – That is a 450% increase over the first quarter of 2011.

With increasing availability of new smart tools (fitbits, smart refrigerators, etc.) and new digital platforms to make healthcare more available (Doctor on Demand, GetHeal, etc.), we are excited to see how technology will continue to transform the health landscape.

EMMC featured by Healthcare Design

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Thank you to Healthcare Design for highlighting Environments for Health’s work at Eastern Maine Medical Center (EMMC)! Read the full article here.

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EMMC has been a tremendous, long-term client of ours having worked with them on this project from master plan through implementation.

We were proud to see phase 1 open, bringing improved care to the patients and more efficient facilities for the staff. We have a great team continuing phase 2 of the project in Bangor – keep up the good work!