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"Hospital Design and Construction - methods"
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Advancing evidence-based healthcare facility design: a systematic literature review
Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.
Journal Article
Multi-objective layout optimization of hospital outpatient clinics based on NSGA II
This study utilizes an improved NSGA-II algorithm to conduct a multi-objective optimization of the hospital outpatient department layout. By simultaneously incorporating patient walking distance, hospital operating costs, patient waiting time, and medical staff work efficiency as optimization objectives, and adopting an adaptive population size adjustment strategy, this paper optimizes the existing outpatient layout in a case study of a three-story outpatient building at Panzhihua Central Hospital. The results show that the new plan reduces patient walking distance by 57.2%, shortens waiting time by 59%, and enhances medical staff collaboration efficiency, while only increasing costs by 5.6%. This demonstrates the effectiveness and feasibility of the improved NSGA-II method in handling complex multi-objective optimization problems for outpatient layouts. The research findings provide a reference for the rational allocation of hospital outpatient resources and the improvement of service quality. Additionally, this paper discusses the applicability and limitations of the study and proposes future research directions, including validating the method’s effectiveness in hospitals of various types and sizes, incorporating dynamic optimization and real-time data, and deeply integrating with hospital information systems.
Journal Article
Feasibility of intelligent logistics management for operational efficiency in smart hospitals: a case study
It is imperative to enhance the scientific management of logistics through the creation and advancement of an Intelligent Logistics Management in Smart Hospitals. This paper presents a preliminary introduction to an intelligent logistics management system. The subsequent section offers a comprehensive overview of the diverse platforms that constitute the intelligent logistics management system. These include the energy management platform, intelligent lighting control platform, one-stop service platform, power operation and maintenance monitoring platform, and the BIM O&M platform, the latter of which is visualised. Furthermore, it provides a comprehensive account of the construction, architectural design, and the functions and responsibilities of the constituent sub-platforms. Furthermore, a thorough examination is conducted to ascertain the substantial efficacy and energy-saving impact of implementing an intelligent logistics management system within the context of a hospital project in Shenzhen, China. The findings indicate a substantial reduction in the energy consumption of the entire building structure, with the maximum total energy consumption reduced by 402 MWh, signifying an 18.5% decline. The system has been demonstrated to reduce operational costs and facilitate environmentally conscious operations, which represents a core objective. The construction of the logistics operation and maintenance platform serves to enhance the efficiency of integrated logistics management, as well as the degree of management refinement. The management system, which employs information technology, is an effective tool for the oversight and enhancement of logistics management. Furthermore, the system provides logistical support for the construction of an environmentally sustainable hospital.
Journal Article
The role of dedicated biocontainment patient care units in preparing for COVID-19 and other infectious disease outbreaks
In response to the Ebola outbreak of 2014–2016, the US Office of the Assistant Secretary for Preparedness and Response (ASPR) established 10 regional treatment centers, called biocontainment units (BCUs), to prepare and provide care for patients infected with high-consequence pathogens. Many of these BCUs were among the first units to activate for coronavirus disease 2019 (COVID-19) patient care. The activities of the Johns Hopkins BCU helped prepare the Johns Hopkins Health System for COVID-19 in the 3 domains of containment care: (1) preparedness planning, education and training, (2) patient care and unit operations, and (3) research and innovation. Here, we describe the role of the JH BCU in the Hopkins COVID-19 response to illustrate the value of BCUs in the current pandemic and their potential role in preparing healthcare facilities and health systems for future infectious disease threats.
Journal Article
Visibility-based layout of a hospital unit – An optimization approach
A patient fall is one of the adverse events in an inpatient unit of a hospital that can lead to disability and/or mortality. The medical literature suggests that increased visibility of patients by unit nurses is essential to improve patient monitoring and, in turn, reduce falls. However, such research has been descriptive in nature and does not provide an understanding of the characteristics of an optimal inpatient unit layout from a visibility-standpoint. To fill this gap, we adopt an interdisciplinary approach that combines the human field of view with facility layout design approaches. Specifically, we propose a bi-objective optimization model that jointly determines the optimal (i) location of a nurse in a nursing station and (ii) orientation of a patient's bed in a room for a given layout. The two objectives are maximizing the total visibility of all patients across patient rooms and minimizing inequity in visibility among those patients. We consider three different layout types, L-shaped, I-shaped, and Radial; these shapes exhibit the section of an inpatient unit that a nurse oversees. To estimate visibility, we employ the ray casting algorithm to quantify the visible target in a room when viewed by the nurse from the nursing station. The algorithm considers nurses' horizontal visual field and their depth of vision. Owing to the difficulty in solving the bi-objective model, we also propose a Multi-Objective Particle Swarm Optimization (MOPSO) heuristic to find (near) optimal solutions. Our findings suggest that the Radial layout appears to outperform the other two layouts in terms of the visibility-based objectives. We found that with a Radial layout, there can be an improvement of up to 50% in equity measure compared to an I-shaped layout. Similar improvements were observed when compared to the L-shaped layout as well. Further, the position of the patient's bed plays a role in maximizing the visibility of the patient's room. Insights from our work will enable understanding and quantifying the relationship between a physical layout and the corresponding provider-to-patient visibility to reduce adverse events.
Journal Article
Design Criteria of Shelter Hospitals in Response to Biological Accidents: A Systematic Review
The appropriate response to mass causality biological events requires well-established preparedness and providing a surge capacity. In such a situation, a practical solution is to convert large public venues into shelter hospitals. Due to the lack of a guideline for the transformation of a large public center into a hospital, the present study collected the design criteria for the transformation of public buildings into shelter hospitals in response to biological events such as epidemics or mass causality biological accidents.
The keywords were searched in Scopus, Web of Science, and PubMed databases until November 2021. This systematic review was conducted using terms related to mass causality biological accidents, shelter hospitals, and design criteria.
Of 1802 extracted articles, duplicates (
= 280) and unrelated publications (
= 1342) were left out in the initial evaluation. Among 180 remained papers, 29 records satisfied our criteria after reviewing abstracts and full texts. Most of the included studies were related to the transformation of public venues into hospitals in response to the coronavirus disease 2019 (COVID-19) pandemic. The investigated themes included site selection, layout and structure, waste and wastewater management, ventilation, communication, food and medicine delivery, humanitarians and social supports, post-treatment care, and Management measures.
In summary, large public venues are highly recommended alternatives for surge capacity in response to mass causality biological accidents. However, the main challenges for using these centers are the provision of basic requirements such as water and electricity, ventilation, and available space.
Journal Article
The Creation of a Biocontainment Unit at a Tertiary Care Hospital. The Johns Hopkins Medicine Experience
In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment.
Journal Article