The physical environment and patient safety: an investigation of physical environmental factors associated with patient falls

(Georgia Institute of Technology, 2011-11-21) Choi, Young-Seon

Patient falls are the most commonly reported "adverse events" in hospitals, according to studies conducted in the U.S. and elsewhere. The rate of falls is not high (2.3 to 7 falls per 1,000 patient days), but about a third of falls result in injuries or even death, and these preventable events drive up the cost of healthcare and, clearly, are harmful outcomes for the patients involved. This study of a private hospital, Dublin Methodist Hospital, in Dublin, Ohio analyzes data about patient falls and the facility's floor plans and design features and makes direct connections between hospital design and patient falls. This particular hospital, which was relatively recently constructed, offered particular advantages in investigating unit-layout-related environmental factors because of the very uniform configuration of its rooms, which greatly narrowed down the variables under study. This thesis investigated data about patients who had suffered falls as well as patients with similar characteristics (e.g., age, gender, and diagnosis) who did not suffer falls. This case-control study design helps limit differences between patients. Then patient data was correlated to the location of the fall and environmental characteristics of the locations, analyzed in terms of their layout and floor plan. A key part of this analysis was the development of tools to measure the visibility of the patient's head and body to nurses, the relative accessibility of the patient, the distance from the patient's room to the medication area, and the location of the bathroom in patient rooms (many falls apparently occur during travel to and from these areas). From the analysis of all this data there emerged a snapshot of the specific rooms in the hospital being analyzed where there was an elevated risk of a patient falling. While this finding is useful for the administrators of that particular facility, the study also developed a number of generally applicable conclusions. The most striking conclusion was that, for a number of reasons, patients whose heads were not visible from caregivers working from their seats in nurses' stations and/or from corridors had a higher risk of falling, in part because staff were unable to intervene in situations where a fall appeared likely to occur. This was also the case with accessibility; patients less accessible within a unit had a higher risk of falling. The implications for hospital design are clear: design inpatient floors to maximize a visible access to patients (especially their heads) from seats in nurses' stations and corridors.
Bayesian calibration of building energy models for energy retrofit decision-making under uncertainty

(Georgia Institute of Technology, 2011-11-10) Heo, Yeonsook

Retrofitting of existing buildings is essential to reach reduction targets in energy consumption and greenhouse gas emission. In the current practice of a retrofit decision process, professionals perform energy audits, and construct dynamic simulation models to benchmark the performance of existing buildings and predict the effect of retrofit interventions. In order to enhance the reliability of simulation models, they typically calibrate simulation models based on monitored energy use data. The calibration techniques used for this purpose are manual and expert-driven. The current practice has major drawbacks: (1) the modeling and calibration methods do not scale to large portfolio of buildings due to their high costs and heavy reliance on expertise, and (2) the resulting deterministic models do not provide insight into underperforming risks associated with each retrofit intervention. This thesis has developed a new retrofit analysis framework that is suitable for large-scale analysis and risk-conscious decision-making. The framework is based on the use of normative models and Bayesian calibration techniques. Normative models are light-weight quasi-steady state energy models that can scale up to large sets of buildings, i.e. to city and regional scale. In addition, they do not require modeling expertise since they follow a set of modeling rules that produce a standard measure for energy performance. The normative models are calibrated under a Bayesian approach such that the resulting calibrated models quantify uncertainties in the energy outcomes of a building. Bayesian calibration models can also incorporate additional uncertainties associated with retrofit interventions to generate probability distributions of retrofit performance. Probabilistic outputs can be straightforwardly translated into a measure that quantifies underperforming risks of retrofit interventions and thus enable decision making relative to the decision-makers' rational objectives and risk attitude. This thesis demonstrates the feasibility of the new framework on retrofit applications by verifying the following two hypotheses: (1) normative models supported by Bayesian calibration have sufficient model fidelity to adequately support retrofit decisions, and (2) they can support risk-conscious decision-making by explicitly quantifying risks associated with retrofit options. The first and second hypotheses are examined through case studies that compare outcomes from the calibrated normative model with those from a similarly calibrated transient simulation model and compare decisions derived by the proposed framework with those derived by standard practices respectively. The new framework will enable cost-effective retrofit analysis at urban scale with explicit management of uncertainties.
An investigation on task interruptions and the physical environment for human performance

(Georgia Institute of Technology, 2011-07-14) Seo, Hyun-Bo

Many dangerous or tragic events such as airplane crashes and medical errors are often the result of human errors, and these errors are often the result of a professional worker being interrupted during a critical task. Although their impact can be serious, the ways that interruptions are affected by the physical environment have rarely been examined in the study of architecture. Therefore, this thesis investigates how the physical environment helps manage the interruptions by observing the process of medication administration by nurses in hospital units. Nurse shadowing observation data showed that the level of visibility of work areas in and around nurse stations significantly contributed to the number of interruptions initiated by others. Therefore, this thesis concludes that the physical environment affects interruption events and discusses the design implications of observation-based findings and the potential impact of the physical environment on major clinical errors. As for future directions for investigation, this thesis suggests that interruptions become a more prominent subject for consideration in architecture, and the physical environment as a subject for analyzing interruption and performance in human factors and health care.
Framework for owner's project requirements for total structural systems (oprtss)

(Georgia Institute of Technology, 2011-07-08) Rouhi, Soheil

As Total Building Commissioning (TBCX) gaining acceptance and becoming a required process for federal, state and LEED projects, the required system guidelines are likewise being developed per Guideline 0-2005 recommendations. One of the most essential systems of any construction process is the structural system; however, there has been limited research in developing a guideline dedicated to structural systems. The Owner's Project Requirement (OPR) is the heart and soul of every guideline, in which Owners specify the requirements of the project in each system. A well-developed OPR for any system will guide the project stakeholders to achieve this goal; it will also, identify the responsibility of professionals in each system of the TBCX. To address this need, this fundamental research will develop a framework for the Owner's Project Requirement (OPR) for Total Structural Systems (OPRTSS). The goal of this research is to develop a model for identifying and implementing the major design and construction variables that impact structural performance of a project, especially during project delivery of concrete or steel framed projects; these are variables that are generally not defined or required by contracts, applicable building codes or engineering principles; that need to be outlined at the pre-design stage. Then, these variables are incorporated into the OPR to reduce the design and construction process uncertainty and help to achieve Owner's requirements for the project. Consequently this will increase Owners satisfaction, quality of the built environment and reduce time, cost and litigation.
Challenges of sustainable urban planning: the case of municipal solid waste management

(Georgia Institute of Technology, 2011-07-08) Ai, Ning

This study aims to demonstrate the critical role of waste management in urban sustainability, promote planners' contribution to proactive and efficient waste management, and facilitate the integration of waste management into mainstream sustainability planning. With anticipated increases in population and associated waste generation, timely and effective waste management highlights one of the most critical challenges of sustainable development, which calls for meeting "the needs of the present without compromising the ability of future generations to meet their own needs" (WCED, 1987). Waste management in urban areas plays a particularly important role, given that waste generated from urban areas are often exported out of the region for processing and treatment, and the impacts of waste disposal activities may pass on to the other jurisdictions, and even to the next generations. An urban system cannot be sustainable if it requires more resources than it can produce on its own and generates more wastes than the environment can assimilate. The current waste management practice, which focuses on short-term impacts and end-of-pipe solutions, is reactive in nature and inadequate to promote sustainability within urban systems, across jurisdictions, and across generations. Through material flows in and out of urban systems, many potential opportunities exist to reduce waste generation and to minimize the negative impacts on the environment, the economy, and the society. City planners' involvement in waste management, however, has been largely limited to siting waste management facilities. Linking waste management with three important lenses in planning-land use, economic development, and environmental planning, this study investigates the impacts of urban growth on waste management activities, the need of transforming the reactive nature of current waste management, and the challenges and opportunities that planners should address to promote urban systems' self-reliance of material and waste management needs. This study includes three empirical analyses to complement theoretical discussions. First, it connects waste statistics with demographic data, geographic characteristics, and policy instruments at the county level to examine whether waste volume can be decoupled from urban population growth. Second, it examines the life cycle costs of different waste management options and develops a simulation study to seek cost-effective strategies for long-term waste management. Third, it compiles evidence of geographic-specific characteristics related to waste management and demonstrates why waste management policies cannot be one-size-fit-all. This study finds that, with successful implementation of strategic policy design, waste generation and its associated impacts can be decoupled from population and urban growth. Good lessons about waste reduction programs can be learned from different communities. Meanwhile, this study also reveals various challenges facing communities with heterogeneous characteristics, such as housing density, building age, and income. Accordingly, this study discusses the potential opportunities for planners to contribute to community-specific waste management programs, the prospect of transforming waste management practice from a cost burden to a long-term economic development strategy, and the need to incorporate waste management into the sustainable urban planning agenda.
An ethnographically informed analysis of design intent communication in BIM-enabled architectural practice

(Georgia Institute of Technology, 2011-07-05) Abdelmohsen, Sherif Morad Abdelkader

The building information model (BIM) is assumed to encompass all the required parameters, rules and attributes about a design product and process for Architecture-Engineering-Construction (AEC) practitioners in a way that is comprehendible by all participants sharing the model and that communicates their needs and intentions. The socio-cognitive day-to-day interactions that occur in the workplace imply however that there are discrepancies between what is exchanged as design information when sharing a model and what is exchanged as goals, needs and possibly conflicting intentions and interests when sharing a common ill-structured problem. The findings of an ethnographic study are presented. The study investigates affordances and limitations in BIM-enabled practice regarding the communication of design intent among design teams in the context of an architectural project. Grounded theory coding was used as a basis for analytic induction through constant comparison and examination of data from field observation, interviews and design meetings, to identify emergent conceptual categories central to the research inquiry. A "thick description" was provided that took into account the dynamic interactions among teams, including interdisciplinary, intradisciplinary and non-disciplinary interaction. By dissecting hypothetical models of shared project information offered by BIM, the dissertation identified interfaces of information exchange, states of the BIM model as a boundary object, and emergent and overlapping communities of practice that delineate the degree of completeness and correctness of a BIM model and describe its effectiveness in capturing and conveying the intent of participants upon interaction. To draw parallels to other contexts, the assumptions central to the study were discussed in relation to a spectrum of possible scenarios within the larger population of AEC firms. In light of the findings and "persona" descriptions identified in the study, the dissertation examined and proposed amendments and richer descriptions to existing surveys and market reports that address the use and benefits of BIM in the AEC industry, including topics such as the internal business value of BIM, top ways to improve value of BIM, and impact of project factors on BIM value.
Development of robust building energy demand-side control strategy under uncertainty

(Georgia Institute of Technology, 2011-05-25) Kim, Sean Hay

The potential of carbon emission regulations applied to an individual building will encourage building owners to purchase utility-provided green power or to employ onsite renewable energy generation. As both cases are based on intermittent renewable energy sources, demand side control is a fundamental precondition for maximizing the effectiveness of using renewable energy sources. Such control leads to a reduction in peak demand and/or in energy demand variability, therefore, such reduction in the demand profile eventually enhances the efficiency of an erratic supply of renewable energy. The combined operation of active thermal energy storage and passive building thermal mass has shown substantial improvement in demand-side control performance when compared to current state-of-the-art demand-side control measures. Specifically, "model-based" optimal control for this operation has the potential to significantly increase performance and bring economic advantages. However, due to the uncertainty in certain operating conditions in the field its control effectiveness could be diminished and/or seriously damaged, which results in poor performance. This dissertation pursues improvements of current demand-side controls under uncertainty by proposing a robust supervisory demand-side control strategy that is designed to be immune from uncertainty and perform consistently under uncertain conditions. Uniqueness and superiority of the proposed robust demand-side controls are found as below: a. It is developed based on fundamental studies about uncertainty and a systematic approach to uncertainty analysis. b. It reduces variability of performance under varied conditions, and thus avoids the worst case scenario. c. It is reactive in cases of critical "discrepancies" observed caused by the unpredictable uncertainty that typically scenario uncertainty imposes, and thus it increases control efficiency. This is obtainable by means of i) multi-source composition of weather forecasts including both historical archive and online sources and ii) adaptive Multiple model-based controls (MMC) to mitigate detrimental impacts of varying scenario uncertainties. The proposed robust demand-side control strategy verifies its outstanding demand-side control performance in varied and non-indigenous conditions compared to the existing control strategies including deterministic optimal controls. This result reemphasizes importance of the demand-side control for a building in the global carbon economy. It also demonstrates a capability of risk management of the proposed robust demand-side controls in highly uncertain situations, which eventually attains the maximum benefit in both theoretical and practical perspectives.
High occupancy toll lanes ignoring the potential for a environmental justice violation

(Georgia Institute of Technology, 2011-04-05) Rodgers, Charner Lynn

In the US transportation system, environmental justice (EJ) issues are regulated by a variety of laws to ensure that all have fair treatment with respect to implementation of policies. If State Departments of Transportation adhere to all regulations properly but unconsciously, then an underlying negative impact on a community may still exist as a result of a newly implemented project. Since the implementation of High Occupancy Toll (HOT) lanes are fairly new, and since there have been numerous concerns from the public about their discriminatory nature, a decision support system is needed to identify potential EJ violations and issues when implementing a new or converted HOT lane. No prior model exists. The goal of this research is to assist state's Department of Transportation (DOT) in the early stages of the development of an HOT lane by developing a Potential Environmental Justice Violation Model that will help state agencies predict potential EJ violations before additional resources are invested into a project. By developing a model, this study identifies and classifies characteristic drivers of potential EJ violations related to communities' economic, social, or health and safety status. The Potential Environmental Justice Violation Model (PEJVM) allows state DOTs employees to define and evaluate the distribution of impacts in the relevant categories. The model provides a method for transforming complex qualitative and quantitative data about a project into a user-friendly format where the results can then be visualized using a spider radar diagram to determine the level of impact of each identified variable. The PEJVM was validated using two previous anonymous HOT case studies and demonstrated using the Interstate 85 Case Study in Atlanta, Georgia. This model offers a uniform method of identifying potential environmental justice violations when implementing a HOT lane. The model will also help inform state agencies of potential violations early in the planning stages of HOT lane projects so that the agency can solve any potential EJ issues before additional resources are invested.
Gregarious space, uncertain grounds, undisciplined bodies the Soviet avant-garde and the 'crowd' design problem

(Georgia Institute of Technology, 2011-04-05) Ziada, Hazem

This thesis proposes a theoretical framework for spatial inquiry into conditions of radical social gregariousness, through probing the crowd design problem in the work of the Soviet Rationalist architects (1920s-30s) - particularly their submissions to the Palace of Soviets competition (Moscow 1931-3). Legitimizing the crowd construct as an index of collective consciousness, and examining the early-modern revolutionary crowd's struggles for proclaiming its self-consciousness, this thesis investigates the interwar political phenomenon of amassing large crowds within buildings as a device for constructing collective social relations. The research project is divided into two main parts. The first is concerned with the crowd design problem, identifying this problem not just as the technical task of accommodating large political crowds, but as the basis of the formulation a new kind of conceptual intent in architecture. Finding the competition brief inadequate to in-depth formulation, the thesis investigates three primary sources for the crowd design problem: mass-events, revolutionary-theatre and revolutionary-art. Four components comprise the Crowd Design Problem each seeking legitimacy in the mass of crowd-bodies: i) the problem of crowd configurations; ii) challenges from the kinesthetic-space conception evoked by theatrical director V.E. Meyerhold's Biomechanics; iii) the legitimacy of 'the object' within a spatial-field of intersubjectivity; and iv) the challenge of 'seeing' crowds from immersive viewpoints counteracting representational filters of class privilege. Part-II focuses on the response of the Rationalists--one of the groups participating in the competition--to the crowd design problem. The study unearths in their designs a logic of space-making founded in the construction of inter-subjective states of consciousness radically different from prevailing individualistic conceptions of social space. To explain this logic of space-making, it proposes the notion of Gregarious Space--a theoretical framework of inquiry into what Marx called "species-being", taking radical gregariousness as the primary, generative condition of society. Besides drawing on morphological principles, social theory, historical analyses, and philosophical reflections, the notion of Gregarious Space is found to be particularly amenable to design propositions. Within the proposed theoretical framework, the Rationalists' design-proposition of curved-grounds, dense notations, textured co-visibilities and empathetic graphic conventions - all comprise a founding spatial-principle trafficking in rhythmic fields between subjects and against non-commodified objects: a principle which challenges the material domain of Productivist Constructivism as well as Historical Materialism's canonical constructs of alienation. Moreover, its uncertain kinesthetics sustain dynamic, aleatory states of consciousness which subvert prevailing disciplinary techniques of Panopticon inspection.
Developing evidence based design metrics and methods for improving healthcare soundscapes

(Georgia Institute of Technology, 2011-04-04) Okcu, Selen

Healing and clinical work requires a complex choreography of architectural acoustic design in healthcare settings. In most healthcare settings, medical staff members conduct vital tasks that may have life-and-death implications. Patients visit the hospitals to heal. Their expectations include fast recovery, restful sleep, and privacy (i.e., speech privacy). However, sound environment qualities of the care settings often fall far from supporting the mission of hospitals. There is strong and growing evidence showing that effective soundscapes in healthcare settings potentially impact errors, healing and stress for patients, families and staff but it is still not clear what measures of the sound environment best predict key healthcare outcomes and what design strategies best impact those measures. By using a multi-method approach (i.e., objective and subjective noise level measurements, in-situ impulse response measurements, heuristic design analysis, theoretical studies, acoustic simulations and statistical analysis), this study aims to develop evidence based design strategies by statistically defining the relationships between three types of variables: (1) architectural floor-plate design metrics, (2) acoustic metrics, and (3) occupant response. The research is conducted in three phases. The first phase of the study compared the objective and subjective qualities of the hospital sound environments with different architectural designs, assessed the effectiveness of a newer acoustic metrics in capturing caregiver perceptions, and evaluated the impact of particular noise sources on caregiver outcomes. The second phase of the study tested the validity of an acoustic simulation tool in estimating the acoustic qualities of the healthcare soundscapes. The third phase of the study systematically explored the relationship between floor-plate design and acoustics of complex inter-connected nursing unit corridors. Even though the relationship between design and acoustics of proportional spaces (a.k.a. rooms with more traditional dimensions) has been well documented, the number of studies linking design and acoustics of complex non-proportional spaces such as inter-connected corridors still remains limited. The findings of the first phase show that critical care sound environments with different designs can vary drastically and impact caregivers` perceived wellbeing and task performance (e.g., patient auditory monitoring). Despite their extensive use, traditional noise metrics sometimes may not be effective in capturing unique characteristics of healthcare sound environments. This study validated the effectiveness of a new more detailed noise metric, "occurrence rate", in capturing the differences between acoustic characteristics of healthcare sound environments. Moreover, particular noise sources such as impulsive noises are likely to dominate the ICU sound environments and interfere with perceived caregiver health and performance. The findings of the second phase suggest the potential effectiveness of acoustic simulation tools (with hybrid prediction programs) in estimating the acoustic qualities of complex inter-connected hospital corridors. The findings of the third phase suggest the potential significant impact of design features of particular hallways (e.g., number of turns, corridor length, and number of branches) and overall floor-shape characteristics of inter-connected corridors (i.e., relative grid distance, and visual fragmentation) on reverberation time. Overall, in the units with shorter, more compact, fragmented corridors with multiple number of branching hallways, reverberation times are likely to be less. Moreover receivers located at the corridors with less number of turns from the sound source also potentially experience lower reverberation times. According to previous research, the human auditory system`s ability to monitor auditory cues is likely to be higher in the less reverberant sound environments.