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Patient safety begins with proper planning: a quantitative method to improve hospital design
  1. D J Birnbach1,
  2. I Nevo1,
  3. S R Scheinman1,
  4. M Fitzpatrick1,
  5. I Shekhter1,
  6. J L Lombard2
  1. 1University of Miami Miller School of Medicine, University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida, USA
  2. 2School of Architecture, University of Miami, Miami, Florida, USA
  1. Correspondence to David J Birnbach, University of Miami Miller School of Medicine, University of Miami-Jackson Memorial Hospital Center for Patient Safety, PO Box 016370 (R-370A), Miami, FL 33101, USA; dbirnbach{at}


Background A quantitative methodology that enhances design of patient-safe healthcare facilities is presented. The prevailing paradigm of evaluating the design of healthcare facilities relies mainly on postconstruction criticism of design flaws; by then, design flaws may have already negatively affected patient safety. The methodology presented here utilises simulation-based testing in real-size replicas of proposed hospital designs. Other simulations to assess design solutions generated mainly qualitative data about user experience. To assess the methodology, we evaluated one patient safety variable in a proposed hospital patient room.

Method Fifty-two physicians who volunteered to participate were randomly assigned to examine a standardised patient in two hospital room settings using a replica of the proposed architectural plan; the two settings differed only by the placement of the alcohol-based hand-rub dispenser. The primary outcome was the hand hygiene compliance rate.

Results When the dispenser was in clear view of the physicians as they observed the patient, 53.8% sanitised their hands. When the dispenser was not in their field of view (as in the original architectural plan), 11.5% sanitised their hands (p=0.0011). Based on these results, the final architectural plans were adjusted accordingly.

Conclusion The methodology is an effective and relatively inexpensive means to quantitatively evaluate proposed solutions, which can then be implemented to build patient-safe healthcare facilities. It enables actual users to proactively identify patient safety hazards before construction begins.

  • Patient safety
  • simulation
  • architecture
  • hand hygiene
  • Healthcare-associate Infection (HAI)

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  • Funding HRSA grant award C76HF10860-01-00.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Miami Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.