Intensive care unit design and mortality in trauma patients

Area of Science:

• Medical architecture
• Trauma intensive care
• Patient safety and outcomes

Background:

• Medical facility architecture can influence patient safety, but its effect on patient outcomes remains unclear.
• This study investigated whether patient room visibility from a central nursing station impacts outcomes in a trauma intensive care unit.

Purpose of the Study:

• To test the hypothesis that patients in highly visible rooms (HVRs) experience better outcomes than those in less visible rooms (LVRs).
• To determine the relationship between room visibility and patient mortality and intensive care unit (ICU) length of stay (LOS).

Main Methods:

• Retrospective evaluation of 773 trauma intensive care patients over 12 months.
• Comparison of outcomes (hospital mortality, ICU LOS) between patients in high-visibility rooms (HVRs) and low-visibility rooms (LVRs).
• Statistical analysis controlling for patient acuity variables: age, Charlson Comorbidity Index (CCI), Head Abbreviated Injury Score, and Injury Severity Score (ISS).

Main Results:

• Unadjusted mortality was 16% in HVRs versus 11% in LVRs (P=0.03).
• After controlling for acuity, ICU mortality did not differ significantly between HVRs and LVRs (P=0.076).
• Visibility was not a predictor of ICU LOS or complications; only ISS significantly predicted ICU LOS and complications.

Conclusions:

• Trauma patient room placement in the ICU, based on visibility, is not significantly related to mortality when patient acuity is considered.
• Patient age, ISS, and CCI are significant predictors of mortality.
• A policy prioritizing critically ill patients for high-visibility rooms might mitigate increased mortality in high-acuity cases.