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to design and build health care facilities founded on research or the best available information, ensuring that the relatively permanent physical environment facilitates the delivery of quality care, thereby improving patients' outcomes and safety. 2 Review of the Literature on EBD in Critical and Acute CareSubstantial support exists for the view that a health care structure itself affects quality of care, patients' safety and satisfaction, as well as staff satisfaction and service efficacy. 3 In a report to the Center for Health Design funded by the Robert Wood Johnson Foundation, Ulrich and associates 4 identified more than 600 studies that link hospital design with clinical outcomes. In recent years, evidence-based design (EBD) has become a more pronounced guiding principle in health care. The concept of EBD is BACKGROUND In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006.OBJECTIVE To determine perceptions of patients and their families of evidence-based design features in a new heart center.METHODS Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. RESULTS Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed.CONCLUSIONS Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care. This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss the concept of evidence-based design in health care environments 2. Identify evidence-based design features associated with improved patient care 3. Recognize the role of physical environment in influencing patient outcomes

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives: Patients' characteristics and infections were collected from hospital databases. Event rates were described by using total counts and rates per 100 patient days and were compared between groups by using generalized linear mixedeffect models weighted by patients' ICU length of stay. Results Overall, 4056 patients from 6 ICUs received disposable and 3184 patients from 5 ICUs received reusable ECG-LWs. The characteristics of the 2 groups were similar, except patients receiving disposable ECG-LWs were less likely to be discharged home (P = .03) and had more comorbid conditions (P = .002).Overall infection rates did not differ between ECG-LW groups, between groups in matched ICUs, between groups by infection type, or when only patients with ICU stays longer than 48 hours were considered (2578 cases). In multivariate analyses, infection rates did not differ between all patients in ECG-LW groups or for patients with ICU stays beyond 48 hours (both P = .10).Conclusions No difference was observed in infection rates of ICU patients receiving disposable versus reusable ECG-LWs.