Conducting a broad organisational systematic review: examining the effect of sensory environments on health-related outcomes of hospital patients

Article type
Authors
Drahota A, Dean T, Stores R, Ward D, Galloway E
Abstract
Background: Huge investments are being made into the renewal and renovation of healthcare estates worldwide. Health care managers are very interested in whether the new facilities have any effect on patient outcomes ('healing design'). A wealth of literature has been published on this topic (www.healthdesign.org) but the principles of evidence-based practice are only just emerging in the field. Synthesising the best available evidence in the form of a systematic review (SR) is a major step in the move towards evidence-based hospital design.

Objectives: This presentation will outline the logistical and debatable issues of conducting a SR with a broad research question tackling organisation of care and environmental influences.

Methods: It is essential for all SRs to have a well-defined research question; assessing the effects of a topic as wide as 'the hospital environment' is no exception. A broad theme entails casting a wide net to embrace the literature. This review covers over 20 databases in the fields of health, architecture and psychology as well as the contacting of subject area experts and organisations and the surveying of reference lists. An encompassing search strategy was utilised so not to overlook relevant research. Working under the guidance of the Effective Practice and Organisation of Care (EPOC) Group, studies were eligible for inclusion if they were of one of the following designs: Randomised Controlled Trial (RCT), Controlled Clinical Trial (CCT), Controlled Before and After (CBA) or Interrupted Time Series (ITS).

Results: Hundreds of thousands of articles were retrieved, many of which were irrelevant. Handling and structuring the results is complex when there is an array of potentially overlapping sub-themes. This review will be organised by intervention and broken down further by outcome.

Conclusions: This initial SR on 'healing hospital environments' aims to be as inclusive as possible whilst still adhering to the strict quality criteria of the Cochrane Collaboration. Such a broad research question is rare within the Cochrane Library and results in a highly complex review. Organisation is paramount and time and patience is key to successful completion.