A seminal comparative study by Roger Ulrich, published in Science in 1984, revealed that having a window view may influence recovery from surgery, and additional research has found that severely ill patients who are assigned to ICU rooms that are not well visualised by the medical staff may experience worse outcomes. However, little research has investigated how room features such as single versus double occupancy, distance from a nursing station, and a window view may impact clinical outcomes.

Researchers at the University of Michigan sought to understand whether certain hospital room features impact mortality and length of stay after surgery.

“We were fascinated to see from a previous study that mortality was different in rooms that were in the line of sight of a nurses’ station,” said study co-author Mitchell J. Mead, a health and design scholar at the University of Michigan. “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.

“One of the next big steps for healthcare design is to understand these pathways of causation that can lead to different clinical outcomes in patients staying in hospital rooms with different features.”

Analysis for this single-site study involved 3964 patients who underwent 13 high-risk surgical procedures, including colectomy, pancreatectomy, and kidney transplant, at the University of Michigan Hospital between 2016 and 2019. Patients were admitted to rooms on two hospital floors. 

Patient rooms were coded based on their features: window or no window; single occupancy; double occupancy; distance to the nursing station; and line of sight to clinicians. Patient encounters were linked by room number to identify clinical outcomes, including mortality and length of stay, related to room design. 

Key findings

Mortality rates for high-risk procedures varied across room design features and room type. Room features that influenced clinical outcomes after surgery included distance from a nursing station, single-room occupancy, and having a direct line of sight where clinicians can see into the room. 

After adjusting for patient co-morbidities and complexity of the operation, mortality rates were 20-per-cent higher if patients were admitted to a hospital room without a window than if they were put in a room with a window. For patients staying in a room without a window, 30-day mortality rates were 10-per-cent higher.

Although mortality rates varied across room design, mortality rates didn’t vary by room type after accounting for length of stay, suggesting that length of stay doesn’t account for differences in mortality.

“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,” explained Mead.

When the authors looked at different rooms based on the favourable design features, they found that the sicker patients were more likely to get single rooms closer to a nursing station and within direct line of sight, as well as a window view.

Further studies

Co-author of the study Andrew M. Ibrahim MD, assistant professor of surgery, architecture, and urban planning at the University of Michigan and co-director of the Center for Outcomes and Policy, said: “I think we can get a much better return on what we build, and hopefully design safer, healthier hospitals.”

Future studies should investigate these outcomes at multiple hospitals to find out if the results can be generalised, the authors suggest. They are in the process of replicating a similar study across Michigan Medicine and hope to recruit collaborators across other hospital systems.

The researchers also hope to expand their study to include other metrics, such as use of pain medication and patient satisfaction across these room types. 

“The common question we get asked is ‘do you want us to rebuild our hospitals?’” Dr Ibrahim said. “Of course, that is not practical. But we do recognise clear patterns where certain room types have better outcomes after surgery.

“We can start to prioritise the sickest patients there. Just the way we’ve 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 optimise outcomes collectively.” 

The study was funded by the Department of Surgery at the University of Michigan.