Exploring spatial risk: The impact of visibility on ICU mortality

Abstract

The relationship between inpatient hospital layouts and a myriad of outcomes – noise, falls, patient experience of care, and mortality – continues to fascinate the clinical and architectural communities. Indeed, optimal patient visibility from nursing stations has long been a significant design consideration. Previous research focused on linear distance and frequency of visits between nurse stations and patient rooms, barriers to interaction (doors), and staff distribution in the workspace; the direct association with clinical outcomes was largely measured by proxy or inferred. The purpose of this dissertation study was to systematically investigate the association between visibility and ICU mortality with a three-pronged approach: (1) alternate visibility metrics and a theoretical extension, (2) introduction of a new variable - isovist connectivity, and (3) testing isovist connectivity meaning and significance against ICU patient mortality. Consistent with previous studies, poorly visible and connected rooms were independently associated with higher ICU patient mortality compared to highly visible and connected rooms. Furthermore, the poor rooms were not intuitively apparent while conforming to accepted practice, suggesting the need for robust spatial analysis to determine level of exposure.