Simulated ‘hospital’ gives real insight

In response to research on the biological and psychological impact of lighting on healthcare outcomes, as well as feedback from patients and clinicians, Trumpf has developed a number of simulated hospital environments at its new showroom in Luton (HEJ – February 2010), which aim to address key issues encountered in ICUs, as well as operating rooms and neonatal units. The units are designed to provide a realistic demonstration of concepts aimed at improving the patient experience, enhancing recovery, and increasing surgeon comfort and performance, as well as offering opportunities for shared learning and training. On arrival at the simulated hospital environment, visitors enter a room designed to mimic an ICU, which has been designed to reduce the psychological impact associated with the patient’s experience of intensive care. Environmental factors resulting in sleep deprivation, sensory deprivation, and abnormal lighting conditions, have all been indicated by researchers as factors that may contribute to the development of “postoperative delirium,” explained managing director, Oliver Law. This phenomenon is commonly referred to as: “intensive care syndrome”. There are also a number of studies that suggest that these factors may slow the speed of recovery and that improvements to the patient’s environment could have positive health benefits.

Lighting and ICUs

In fact, a growing body of literature has emerged during the last decade highlighting the important role of lighting in healthcare outcomes and the ICU environment at the Luton facility has taken on board this data in its overall design. A study by Bendetti et al (2001), for example, reported that hospital stay was around 3.67 days shorter in those admitted to rooms facing the east, which received brighter natural light, than those facing the west. A paper in the British Journal of Medical Psychology, published in the same year, also raised the issue of lighting in ICUs as one of a number of factors that affect a patient’s psychological wellbeing when recovering from life-threatening conditions. The paper claimed that between 10% and 20% of people in intensive care or high dependency units developed psychological problems as a result of their experience – ranging from anxiety, nightmares, and flashbacks, to delusions. Dr Ian Bennun, a clinical psychologist at Torbay Hospital at the time of writing the paper, told the BBC: “Part of the problem is the fact that, in an ICU, there is no day or night; there is constant noise and many patients have marked sleep disturbance.” He pointed out that lights, in some cases, are not dimmed at night and, in units where there are no windows, patients have no idea what time of day it is.1 In ICUs, bright lights that are constantly on disturb the patients’ natural circadian rhythms just as much as the frequent monitoring of their vital functions, which is also undertaken at night and usually requires turning on all the lights. Most patients lack private space and the chance to be alone. The Lighting Research Center in the US explains that circadian rhythms are the biological rhythms that repeat approximately every 24 hours. Light is the main stimulus that helps the circadian clock, and thus circadian rhythms keep a synchronised rhythm with the solar day.2 Humans need to be exposed to a sufficient amount of light of the right spectrum, for a sufficient amount of time, and at the right time, for their biological clocks to remain synchronised with the solar day. Otherwise they may experience decrements in physiological functions, neurobehavioural performance, and sleep.2 Recent studies support the view that this should be given greater consideration. For example, a study conducted by the Friedrich-Wilhelms University in Bonn confirmed that the absence of natural light cycles in ICUs is often a hindrance to recovery. More than a third of the patients monitored showed additional signs of depression, anxiety, and confusion, after three to five days. The results of a study which attempted to adjust the circadian rhythms of patients by manipulating light were also published by Taguchi et al in 2007.3 The subjects included 11 patients operated on for oesophageal cancer in Osaka University Hospital in Japan. After informed consent was obtained, they were divided into a study group and a control group by a random sampling method. After removal of the endotracheal tube, the study group was exposed to light of around 5,000 lux. A significant difference was observed in the delirium score between the study group and control group on the morning of day three of bright light therapy by the Mann-Whitney U-test (P=0.014). The study group could begin ambulation about two days earlier than the control group. The researchers concluded that bright light therapy may reduce the rate of postoperative delirium and make early ambulation possible, although they acknowledged that larger samples needed to be investigated. They also pointed out that patients who developed delirium said that they had been irritated by not being able to sleep at night. In view of this body of research, Trumpf’s simulated ICU environment highlights features aimed at improving lighting cycles as well as sensory stimulation. The company’s AmbientLine lighting concept, for example, simulates the natural changing light conditions of day and night through different colours to help synchronise the patient’s circadian rhythms. A flexible ceiling pendant over the patient’s bed also features indirect ceiling and floor lights which are mounted onto its arms and head. These lights are easy to turn on and off, either at the same time or separately, and even from the door. This helps staff get to a patient’s bed easily without waking up other patients, since all the lights in the room do not have to be turned on. More ambient light is introduced into the room by coloured wall lighting that also serves as a night light, while subtle floor lighting and lighting in drawers allow nurses to tend to the patient at night without disturbing other patients. There is also targeted lighting for examination and treatment of different areas of the patient – for the head, mid-section, and lower section. “These may seem like small issues, but the patient needs the best possible chance of recovery and undisturbed rest is a contributory factor,” said Oliver Law. In addition to lighting considerations, above the bed is the facility for a projection screen on which information, communication, and entertainment, can be displayed. Photos of the patient’s family and their messages can be projected, for example, which can help reduce feelings of isolation, as well as sensory deprivation. “There has been a lot of interest from the NHS and we are seeing a trend towards a more holistic approach to patient wellbeing,” said Oliver Law. “Getting the message across to Trusts that these changes will improve the bottom line through faster recovery is extremely important, as time spent in intensive care is very expensive.” Patient safety factors have also been addressed in the ceiling pendant used for essential intensive care and patient monitoring equipment, which has the option of incorporating a camera to enable close CCTV monitoring of patients – providing a reassuring “extra pair of eyes” in an often pressurised environment. The ceiling pendants are operated using a gas-assisted mechanism so that they can be manoeuvred with one hand, to allow quick and unhindered access to the patient. All equipment, sockets, wires and gas outlets are kept off the floor to enable efficient cleaning of the area, as well as health and safety.