Research to Help our Aging Population

March 12, 2012

The healthcare sector is among the fastest growing sectors of the national economy. Hospitals will continue to be the core of the healthcare industry with more than 6,500 hospitals in the United States and $575 billion in annual revenues. Including ancillary activities with doctors’ offices, emergency care facilities and nursing homes, the numbers increase to 820,000 facilities and more than $1 trillion in revenues.

The healthcare sector will continue to grow due to the aging demographics and the expansion of treatment options, including the continued introduction of medical technology. Hospitals and related facilities will continue to offer opportunities in terms of design, technology, and instrumentation. The SmartState Center in Health Facilities Design and Testing offers the potential to be on the cutting edge of the area serving state, national and international healthcare systems. Three main areas of research activity with economic development implications have been undertaken to date:

Inpatient hospital room prototyping and evaluation

Development and implementation of a Post Occupancy Evaluation instrument for healthcare facilities

Development of a human factors research initiative examining clinical practices and environmental conditions in cardiac operating rooms.

Patient Room Prototyping

This work formed and tested the conceptual framework for the original SmartState Center proposal and began prior to the approval of the center. Ongoing design-research-refinement iterations have been conducted since the center’s approval in 200, which is funded through sponsored subcontracts through NXT (a technology-research and development company in South Carolina) with the Department of Defense (DoD) Military Health System and the Robert Mills Endowed Professorship at Clemson. This work has also drawn significant in-kind material and collaboration support from South Carolina-based and national healthcare equipment manufacturers such as Trumpf headquartered in Charleston, S.C., Hill-Rom, Herman Miller Healthcare, Sky Factory, Kohler, and DuPont. The latest round of prototyping are engaging Trumpf in the development of a new patient room headwall prototype.

Discussions are underway to collaborate with Herman Miller Healthcare to bring to market footwall elements of the prototype room and with Sky Factory on new applications of virtual imagery. An initiative by NXT is engaging DuPont in the development of a futuristic “Patient Ribbon” based on the award-winning 2020 Patient Room.

Post Occupancy Evaluation (POE)

Funding from the DoD Military Health System has allowed researcher at Clemson to develop a rigorous POE tool that evaluates performance of built healthcare facilities across multiple measures against original design objectives. Versions of the instrument have been used to validate the instrument and evaluate four inpatient nursing units at Upstate South Carolina hospitals and now multiple departments at two DoD hospitals over the last two funding cycles. It is expected that additional POEs will be conducted for the DoD in the future, and the ultimate goal is to develop a cross study database that can examine trends in areas of success and failure in the design of hospitals.

Human Factors Research in the Cardiac Operating Room

Cardiac surgery is a high-risk procedure performed by a multidisciplinary team using complex tools and technologies. Efforts to improve patient safety and reduce human error for cardiac surgical patients have been ongoing for more than a decade, yet the literature provides little guidance regarding best practices for hazard identification and interventions to effectively reduce risk. Likewise, little research is available to inform the design of operating rooms, leading to reliance on past practices and anecdotal evidence.

Dr. Jake Abernathy, associate professor, MUSC; Dr. Scott T. Reeves, John E. Mahaffe, endowed professor and chairman in the Department of Anesthesia and Perioperative Medicine, MUSC; and Dr. Scott Shappell, professor, Clemson University Department of Industrial Engineering, serve leadership roles at the national planning level for a ground-breaking research project call FOCUS.

The FOCUS initiative is a multi-year, multi-center initiative designed to examine the physical and cultural environment of the cardiac surgery operating rooms and to define processes by which the cardiovascular operative teams can reduce the occurrence of human error. Although every individual involved in cardiovascular operative patient care is dedicated to patient safety, the process and communication patterns that exist are inadequate to achieve the goal of universal patient safety.

The results of that research helped inform the design a s new Agency for Healthcare Research and Quality funded grant. The Agency for Health Research and Quality (AHRQ) recently awarded a three-year research grant of $4 million to Dr. Peter Pronovost and the FOCUS initiative to improve teamwork to prevent infections in cardiac operations. This research is a joint collaboration of the Society of Cardiovascular Anesthesiologists Foundation and the Quality and Safety Research Group at the Johns Hopkins School of Medicine. MUSC is a sub-award recipient of this grant with Abernathy as Principal Investigator.

Seeking to capitalize on the state’s expertise in the areas of human factors engineering, healthcare architecture and cardiac surgery. MUSC’s Department of Anaesthesia and Perioperative Medicine is creating an alliance involving Clemson University’s Graduate Program in Architecture and Health. The goal is to scientifically identify problems associated with operating room design, understand how those design flaws impact patient safety, and use that knowledge to design a safer, more efficient operating room.