From the Department of Design, College of Human Sciences, Texas Tech University, Lubbock, Texas.
Department of Interior Design, College of Design, Construction and Planning, University of Florida.
J Patient Saf. 2021 Jun 1;17(4):273-281. doi: 10.1097/PTS.0000000000000613.
The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms.
An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews.
After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail.
Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.
本研究旨在识别和评估考察医院病房建筑环境对患者跌倒影响的科学证据。
采用患者-干预-比较-结局（PICO）框架进行综合回顾（IR）和系统文献检索。我们检索了 CINAHL、PsychINFO、PubMed 和 Web of Science 数据库。检索包括 1990 年至 2017 年以英文发表的同行评议研究。还进行了额外的手工检索。根据美国危重病护理护士协会制定的、适用于循证设计系统文献综述的六级证据分类法，对选定的文章进行了回顾和评分。
经过多层次的筛选过程，有 30 篇文章符合入选标准。根据物理环境的检查要素，创建了主题领域，包括患者房间布局和可用空间、浴室布局、浴缸和淋浴、门、床的高度和床栏、地板、地板垫、病人椅、照明、马桶、扶手、抓杆、静脉输液杆、水槽、吊轨、轮椅和助行器。详细讨论了每项要素的研究结果。
过去的关系或因果研究并未考察某些环境要素，且所检查属性的证据水平不足以对医疗保健设计决策获得足够的信心。由于某些环境要素的证据水平较低，因此必须谨慎得出结论。建议使用定量、关系或因果设计进行更多研究，以制定针对医院病房患者跌倒的可操作干预措施。
