Dollars and Sense Supplement

The study cited in Michael’s presentation, McGraw-Hill Construction Health Care Green Building SmartMarket Report, available for purchase at http://construction.ecnext.com/coms2/analytics.

Below are some suggested resources to Michaels’ query about studies supporting better patient outcomes in Hospitals with “green” features:

The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity (available at www.healthdesign.org/research/reports/pdfs/role_physical_env.pdf ) Roger Ulrich*, Xiaobo Quan, Center for Health Systems and Design, College of Architecture, Texas A&M University; Craig Zimring*, Anjali Joseph, Ruchi Choudhary, College of Architecture, Georgia Institute of Technology

Also: The text of the summaries below are from: Ulrich, Roger S. "Biophilia, Biophobia and Natural Landscapes" from The Biophilia Hypothesis, Island Press: 1993. pp. 73-137.

STUDY: Patient recovery and views of nature
ORIGINAL SOURCE: Ulrich, R.S. 1984. "View Through a Window May Influence Recovery from Surgery." Science 224:420-421.
SUMMARY: A study examined patients recovering from gall bladder surgery in a Pennsylvania hospital to evaluate whether assignment to a room with a window view of a natural setting might have therapeutic influences (Ulrich 1984). Recovery data were compared for pairs of patients who were closely matched for variables that could influence recovery such as age, sex, weight, tobacco use, and previous hospitalization. The patients were assigned essentially randomly to rooms that were identical except for window view: one member of each pair overlooked a small stand of deciduous trees; the other had a view of a brown brick wall. Patients with the natural window view had shorter postoperative hospital stays, had fewer negative comments in nurses' notes ("patient is upset," "needs much encouragement"), and tended to have lower scores for minor post surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injects of potent painkillers, whereas the tree-view patients more frequently received weak oral analgesics such as acetaminophen.

STUDY: Patient window view preference
ORIGINAL SOURCE: Verderber, S. 1986. "Dimensions of Person-Window Transactions in the Hospital Environment." Environment and Behavior 18:450-466.
SUMMARY: ...findings from a questionnaire study of patients who were severely disabled by accidents or illness (and hence were presumably stressed) suggest than an especially highly preferred category of hospital window views included scenes dominated by natural content (Verderber 1986).

STUDY: Patient recovery and nature images
ORIGINAL SOURCE: Ulrich, R.S., and O. Lunden. 1990. "Effects of Nature and Abstract Pictures on Patients Recovering from Open Heart Surgery." Paper presented at the International Congress of Behavioral Medicine, 27-30 June, Uppsala, Sweden.
SUMMARY: ...Outi Lunden and I (1990) investigated whether exposure to visual stimulation in hospital intensive care units, including simulated natural views, promotes wellness with respect to the postoperative courses of open-heart surgery patients. At Uppsala University Hospital in Sweden, 166 patients who had undergone open-heart surgery involving a heart pump were randomly assigned to a visual stimulation condition consisting of a nature picture (either an open view with water or a moderately enclosed forest scene), an abstract picture dominated by either curvilinear or rectilinear forms, or a control condition consisting of either a white panel or no picture at all. Our findings suggest that the patients exposed to the open view of water experience much less postoperative anxiety than the control groups and the groups exposed to the other types of pictures. The comparatively enclosed forest setting with shadowed areas did not reduce anxiety significantly compared to the control conditions. The rectilinear abstract picture was associated with higher anxiety than the control conditions. Future reports stemming from this research will present findings based on a wide variety of indicators of wellness both physiological (such as blood pressure) and behavioral (such as use of painkillers and post surgical length of stay).

from: http://www.ahrq.gov/qual/hospbuilt/hospenv2.htm

Factors Affecting Length of Stay. A small body of research has been conducted on whether environmental factors influence the length of patients' hospital stays. According to an RCT conducted at the Department of Neuropsychiatric Sciences at the University of Milan, bipolar patients assigned to rooms with more sunlight had a mean 3.67-day shorter hospital stay than patients with the same diagnosis in rooms with little or no sunlight.27 As noted above, studies also have demonstrated the negative effects of windowless hospital rooms on patient outcomes and satisfaction.28 Much of the research suggests that access to sunlight has positive effects on patient outcomes and patient and staff satisfaction.

Ovitt, Margaret. The effect of a view of nature on performance and stress reduction of ICU nurses / by Margaret Ovitt. 1996. vi, 63 leaves, bound : ill. ; 29 cm. Includes bibliographical references (leaves 44-47). 1. Nurses--Job stress. 2. Nursing--Psychological aspects. 4. Work environment. 5. Intensive care nursing. Q.155.91Ov4e / CPX

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