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Introduction Trauma registries have been used internationally for several decades to measure the quality of trauma care between hospitals. Given the significant costs involved in establishing and maintaining trauma registries, and increasing availability of routinely collected, linked health data describing a patient's journey (and inherent cost savings in data re-use), there is significant interest in development of integrated, comprehensive trauma data repositories. However, approaches to estimating injury severity using routinely collected data would need to be developed if routinely collected hospital data were to be used as an alternative/supplement to registries. Objectives This study aimed to compare the accuracy of registry-based injury severity estimates with ICD-based injury severity estimates in predicting mortality outcomes in a cohort of minor and major trauma patients in Queensland, using retrospectively linked trauma registry and hospital admissions data. Methods Queensland Trauma Registry (QTR) data with an admission date between 1 January 2005 and 31 December 2011 was linked with all acute care patients included in the Queensland Hospital Admitted Patient Data Collection (QHAPDC) with a Principal Diagnosis coded with an ICD-10-AM code within Chapter 19 (S00–T98). Abbreviated Injury Scale coding was undertaken manually by QTR trauma data nurses for the registry data. ICD-based injury severity scores (ICISS) were calculated automatically using all injury-related diagnoses captured in the QHAPDC data using the ICISS multiplicative and worst injury method. Results There were 92,140 QTR patients admitted between January 2005 and December 2011 with a valid ISS with a matching QHAPDC record (98.4% survived, 1.6% died). ICISS (multiplicative and worst injury approach) showed marginally better predictive accuracy than ISS when predicting mortality across minor and major injury and ICISS showed marginally better predictive accuracy to ISS when restricted to major trauma/high threat to life cases. Both ICISS and ISS restricted to major trauma/high threat to life showed poorer accuracy compared to the predictive performance when both minor and major cases were included. Conclusion ICD-based predictions were as accurate as ISS-based predictions for this cohort and this study provides evidence to support the potential for using routinely coded hospital data for risk adjustment within State-based trauma data repositories.

BackgroundTreatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications.AimsThis article aims to promote the use of consistent terminology in injury data linkage studies, suggest important factors to consider when managing linked injury data, and encourage thorough documentation and a robust discourse around different approaches to data management to ensure reproducibility, consistency and comparability of analyses arising from linked injury data.ApproachThis paper is presented in sections describing: (1) considerations for identifying injury cohorts, (2) considerations for grouping Episodes into Encounters and (3) considerations for grouping Encounters into Events. Summary tools are provided to aid researchers in the management of linked injury data.DiscussionCareful consideration of decisions made when identifying injury cohorts and grouping data into units of analysis (Episodes/Encounters/Events) is essential when using linked injury data. Choices made have the potential to significantly impact the epidemiological and clinical findings derived from linked injury data studies, which ultimately affect the quality of injury prevention initiatives and injury management policy and practice. It is intended that this paper will act as a call to action for injury linkage methodologists, and those using linked data, to critique approaches, share tools and engage in a robust discourse to further advance the use of linked injury data, and ultimately enhance the value of linked injury data for clinicians and health and social policymakers.

Speeding is a major contributor to deaths and serious injuries in Australia. To assist in speed countermeasure development, VicRoads commissioned an examination of speeding offenders’ characteristics, re-offence and casualty crashes during and after periods of licence sanctions. These analyses aimed to determine the effects of the following sanctions: licence bans; the increase in speeding ban periods and demerit points for higher level speeding offences; additional demerit point bans for high-range offenders in addition to a 12-month speeding ban; and the good behaviour bond available as an alternative to the licence ban after reaching the demerit point threshold. The study had several positive findings, for example licence bans from speeding offences reduced speeding re-offending and casualty crashes; and there were lower re-offence rates for those who elected to take the good behaviour bond when reaching the demerit point limit.

This paper describes research on the design of behavioral and mental health facilities. Using input from clinical staff, the purpose of the study was four-fold: to develop and test a tool for the evaluation of mental and behavioral health (MBH) facilities, to evaluate the importance and effectiveness of specific environmental qualities and features, to generate design guidelines for MBH facilities, and to make recommendations for future research. A draft version of a tool that was intended to measure the importance and effectiveness of environmental qualities and features in MBH facilities was developed using a multi-methods approach. This survey, the Psychiatric Staff Environmental Design (PSED) tool, was distributed to psychiatric nursing organization members (N = 134). The researchers determined that the PSED was suitable for future research with minor modifications. Other findings included staff support for private patient rooms, staff recognition of the critical role of positive distraction, and the importance of aesthetics.

Problem In Australia, as in many other countries, a disproportionate number of drink driving crashes occur on rural roads. Aims and method The study used Queensland Police Random Breath Testing (RBT) data from 2000–2011 to (a) comparing drink driving rates and RBT efficacy in areas of increasing remoteness (b) compare drink driver factors and the circumstances of apprehensions in rural and urban areas. Results Generally, rural areas had a higher detection rate per RBT intercepts and a greater number of apprehensions per licensed drivers than the state average. Main effects showed that rural drivers were more likely to be male and to be a reoffender but less likely to be apprehended between midnight and 5.59 am and after visiting a licensed venue. Urban drivers were more likely to be aged 17‒49 years and to be apprehended with a BAC < 0.15%. Conclusion Differences in RBT effectiveness and drink driving factors and circumstances exist between rural and urban areas. Practical application: The greater number of drink drivers in rural areas signal a need for targeted interventions in these areas. To increase the effectiveness of such interventions, further research should examine the mechanisms responsible for these observed differences between rural and urban drink driver.

Highlights - A proxy definition is a surrogate measure of fatigue applied post hoc to crash data. - Young (16–24 years), novice (first two years of licensure) drivers are overrepresented in sleep-related crashes. - Using a proxy definition removes male gender and high severity as prominent fatigue crash characteristics. - Not all associated risk factors of sleep-related crashes are included in proxy definitions. - Improving sleep-related identification by both police and proxy should be a priority. Abstract Sleep-related (SR) crashes are an endemic problem the world over. However, police officers report difficulties in identifying sleepiness as a crash contributing factor. One approach to improving the sensitivity of SR crash identification is by applying a proxy definition post hoc to crash reports. To identify the prominent characteristics of SR crashes and highlight the influence of proxy definitions, ten years of Queensland (Australia) police reports of crashes occurring in ≥100 km/h speed zones were analysed. In Queensland, two approaches are routinely taken to identifying SR crashes. First, attending police officers identify crash causal factors; one possible option is ‘fatigue/fell asleep’. Second, a proxy definition is applied to all crash reports. Those meeting the definition are considered SR and added to the police-reported SR crashes. Of the 65,204 vehicle operators involved in crashes 3449 were police-reported as SR. Analyses of these data found that male drivers aged 16–24 years within the first two years of unsupervised driving were most likely to have a SR crash. Collision with a stationary object was more likely in SR than in not-SR crashes. Using the proxy definition 9739 (14.9%) crashes were classified as SR. Using the proxy definition removes the findings that SR crashes are more likely to involve males and be of high severity. Additionally, proxy defined SR crashes are no less likely at intersections than not-SR crashes. When interpreting crash data it is important to understand the implications of SR identification because strategies aimed at reducing the road toll are informed by such data. Without the correct interpretation, funding could be misdirected. Improving sleepiness identification should be a priority in terms of both improvement to police and proxy reporting.

Objective: To examine national ladder‐related fall injury patterns and trends, and compare the changes over time in occupational and non‐occupational falls across age groups. Methods: Analysis of national hospital morbidity data to examine trends over time and differences between groups. Results: There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder‐related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non‐occupational falls increased significantly over the ten year period. Conclusions: With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder‐related falls. Implications: This study demonstrates the significant burden that ladder‐related falls are continuing to have on the community, both in the occupational and domestic setting.

Speeding behaviour has been shown to account for a large number of deaths and serious injuries on Australian roads. Vehicle impoundment is one countermeasure which has been implemented to discourage drivers from engaging in high-range speeding. Despite this countermeasure being used as a sanction in all Australian jurisdictions to combat high-range speeding offences, limited research has examined the effectiveness of vehicle impoundments in Australia. The purpose of this research was to examine the effectiveness of vehicle impoundment for high-range speeding offences on subsequent offence and crash rates. Data were collected from drivers with an eligible excessive speeding offence in Victoria, Australia between 1 July 2006 and 31 December 2014. During this time, there were 17,440 impoundment eligible offences, 6,883 (41.8 %) of which resulted in vehicle impoundment. The analysis revealed that drivers who had a vehicle impounded were more likely to be male, younger, hold a probationary licence, and to have a court offence. In terms of the effectiveness of vehicle impoundment, among high-range offenders, re-offence rates for those who had their vehicle impounded were statistically significantly lower for all licence periods compared with offenders who did not have their vehicle impounded. There was evidence of an effect of impoundment on reducing speeding re-offence rates during the impoundment period as well as some evidence that the impact of licence suspension was greater for those who experienced impoundment. Given that vehicle impoundment is a sanction which aims to discourage and/or incapacitate drivers from engaging in on-road risk taking behaviour, in this case high-range speeding behaviour, the longer-term positive effects of this sanction may assist with the on-going effort to reduce on-road risk taking behaviours.

The reliance on police data for the counting of road crash injuries can be problematic, as it is well known that not all road crash injuries are reported to police which under-estimates the overall burden of road crash injuries. The aim of this study was to use multiple linked data sources to estimate the extent of under-reporting of road crash injuries to police in the Australian state of Queensland. Data from the Queensland Road Crash Database (QRCD), the Queensland Hospital Admitted Patients Data Collection (QHAPDC), Emergency Department Information System (EDIS), and the Queensland Injury Surveillance Unit (QISU) for the year 2009 were linked. The completeness of road crash cases reported to police was examined via discordance rates between the police data (QRCD) and the hospital data collections. In addition, the potential bias of this discordance (under-reporting) was assessed based on gender, age, road user group, and regional location. Results showed that the level of under-reporting varied depending on the data set with which the police data was compared. When all hospital data collections are examined together the estimated population of road crash injuries was approximately 28,000, with around two-thirds not linking to any record in the police data. The results also showed that the under-reporting was more likely for motorcyclists, cyclists, males, young people, and injuries occurring in Remote and Inner Regional areas. These results have important implications for road safety research and policy in terms of: prioritising funding and resources; targeting road safety interventions into areas of higher risk; and estimating the burden of road crash injuries.

The number of bike share programs has increased rapidly in recent years and there are currently over 700 programs in operation globally. Australia’s two bike share programs have been in operation since 2010 and have significantly lower usage rates compared to Europe, North America and China. This study sets out to understand and quantify the factors influencing bike share membership in Australia’s two bike share programs located in Melbourne and Brisbane. An online survey was administered to members of both programs as well as a group with no known association with bike share. A logistic regression model revealed several significant predictors of membership including reactions to mandatory helmet legislation, riding activity over the previous month, and the degree to which convenience motivated private bike riding. In addition, respondents aged 18 - 34 and having docking station within 250m of their workplace were found to be statistically significant predictors of bike share membership. Finally, those with relatively high incomes increased the odds of membership. These results provide insight as to the relative influence of various factors impacting on bike share membership in Australia. The findings may assist bike share operators to maximize membership potential and help achieve the primary goal of bike share – to increase the sustainability of the transport system.

Drink-driving remains a major road safety concern that creates a significant social burden. Licence disqualification continues to play a key role in drink driving deterrence and sanctions together with police enforcement to address the problem in most motorised countries. However, on-going questions remain regarding the differing effect of licence disqualification periods between first time and repeat offenders, and between other sub-groups of offenders. As a result, this study aimed to determine whether: (a) differences exist in re-offence rates of convicted drink-drivers between: the period between committing the drink-driving offence and licence disqualification (pre-licence disqualification), during the period of licence disqualification, and after being re-licensed (post-licence restoration); and (b) differential effects of offence rates are evident based on Blood Alcohol Content (BAC), gender, age, repeat offender status and crash involvement at the time of offence. The sample consisted of 29,204 drink-driving offenders detected in Victoria, Australia between 1 January 1996 and 30 September 2002. The analysis indicated that licence disqualifications were effective as drink-driving offenders had a significantly lower rate of offending (both drink-driving and other traffic offences) during licence disqualifications compared to pre-licence disqualification and post-licence restoration periods. The influence of licence disqualification appeared to extend beyond the disqualification period, as offence rates were lower during post-licence restoration than during pre-licence disqualification. Interestingly, the highest rate of offending (both for drink-driving and other traffic offences) was during the pre-licence disqualification period, which suggests offenders are particularly vulnerable to drink and drive while waiting to be sanctioned. A consistent pattern of results was evident across genders and age groups. Additionally, those who were involved in a crash at the same time as their index offence had lower offence rates (compared to those who were not involved in a crash) for all periods, although for general traffic offences, the offence rate was highest in the post-licence restoration period for those who had a crash at index offence. This indicates that being involved in a crash may deter these offenders, at least in the short-term. The implications of the results for managing both first time and repeat offenders are discussed.

Objective: The aim of this exploratory study was to assess factors deemed by patients as "important" as they planned and considered undergoing colorectal cancer CRC screening, and to use this data to design a computer-delivered intervention to promote screening. Methods: Fifty participants 50 years or older, not up-to-date with current recommended CRC screening guidelines, were recruited from a primary care clinic. A semi-structured interview focused on aspects of preparing for colorectal cancer screening was administered; after transcription, researchers used triangulation and consensus to identify relevant themes and concepts. Results: Four main themes were identified that dealt with issues important for both FOBT and colonoscopy planning: personal concerns, reminders, communication with healthcare providers and obtaining test results. FOBT specific themes included: sample collection and return. For colonoscopy screening, themes included: scheduling, intervention questions, colonoscopy preparation, and transportation. These can be classified as barrier, process and accessory themes. The developed computer-administered implementation intentions algorithm addressed all the identified concerns in a planned and sequential manner, in order to facilitate planning for CRC screening. Conclusions: The results of this study suggest that appropriate reminders, explanations of procedures, and patient understanding of temporary life disruptions, help patients develop and accept a detailed screening plan.

Traffic law enforcement sanctions can impact on road user behaviour through general and specific deterrence mechanisms. The manner in which specific deterrence can influence recidivist behaviour can be conceptualised in different ways. While any reduction in speeding will have road safety benefits, the ways in which a ‘reduction’ is determined deserves greater methodological attention and has implications for countermeasure evaluation more generally. The primary aim of this research was to assess the specific deterrent impact of penalty increases for speeding offences in Queensland, Australia, in 2003 on two cohorts of drivers detected for speeding prior to and after the penalty changes were investigated. Since the literature is relatively silent on how to assess recidivism in the speeding context, the secondary research aim was to contribute to the literature regarding ways to conceptualise and measure specific deterrence in the speeding context. We propose a novel way of operationalising four measures which reflect different ways in which a specific deterrence effect could be conceptualised: (1) the proportion of offenders who re-offended in the follow up period; (2) the overall frequency of re-offending in the follow up period; (3) the length of delay to re-offence among those who re-offended; and (4) the average number of re-offences during the follow up period among those who re-offended. Consistent with expectations, results suggested an absolute deterrent effect of penalty changes, as evidenced by significant reductions in the proportion of drivers who re-offended and the overall frequency of re-offending, although effect sizes were small. Contrary to expectations, however, there was no evidence of a marginal specific deterrent effect among those who re-offended, with a significant reduction in the length of time to re-offence and no significant change in the average number of offences committed. Additional exploratory analyses investigating potential influences of the severity of the index offence, offence history, and method of detection revealed mixed results. Access to additional data from various sources suggested that the main findings were not influenced by changes in speed enforcement activity, public awareness of penalty changes, or driving exposure during the study period. Study limitations and recommendations for future research are discussed with a view to promoting more extensive evaluations of penalty changes and better understanding of how such changes may impact on motorists’ perceptions of enforcement and sanctions, as well as on recidivist behaviour.

This paper reports profiling information for speeding offenders and is part of a larger project that assessed the deterrent effects of increased speeding penalties in Queensland, Australia, using a total of 84,456 speeding offences. The speeding offenders were classified into three groups based on the extent and severity of an index offence: once-only low-rang offenders; repeat high-range offenders; and other offenders. The three groups were then compared in terms of personal characteristics, traffic offences, crash history and criminal history. Results revealed a number of significant differences between repeat high-range offenders and those in the other two offender groups. Repeat high-range speeding offenders were more likely to be male, younger, hold a provisional and a motorcycle licence, to have committed a range of previous traffic offences, to have a significantly greater likelihood of crash involvement, and to have been involved in multiple-vehicle crashes than drivers in the other two offender types. Additionally, when a subset of offenders’ criminal histories were examined, results revealed that repeat high-range speeding offenders were also more likely to have committed a previous criminal offence compared to once only low-range and other offenders and that 55.2% of the repeat high-range offenders had a criminal history. They were also significantly more likely to have committed drug offences and offences against order than the once only low-range speeding offenders, and significantly more likely to have committed regulation offences than those in the other offenders group. Overall, the results indicate that speeding offenders are not an homogeneous group and that, therefore, more tailored and innovative sanctions should be considered and evaluated for high-range recidivist speeders because they are a high-risk road user group.

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drink drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs appear to be quite widespread around the world, however a limited number have been subject to rigorous evaluation. This paper reports results from an outcome evaluation of a designated driver program called ‘Skipper’, which was trialled in a provincial city in Queensland, Australia. The outcome evaluation included surveys three weeks prior to (baseline), four months following (1st follow-up), and 16 months following (2nd follow-up) the commencement of the trial in both the ‘intervention area’ (baseline, n = 202; 1st follow-up, n = 211; 2nd follow-up, n = 200) and a ‘comparison area’(baseline, n = 203; 1st follow-up, n = 199; 2nd follow-up, n = 201); and a comparison of random breath testing and crash data before and after the trial. The survey results indicate that awareness of the program in the intervention area was quite high four months following its introduction and that this was maintained at 16 months. The results also suggest that the ‘Skipper’ program and the related publicity had positive impacts on behaviour with an increase in the proportion of people participating in designated driver as a passenger. It is less clear, however, whether the ‘Skipper’ program impacted on other behaviours of interest, such as drink driving or involvement in alcohol-related crashes. Suggestions for further research and program improvement are discussed as well as limitations of the research.

Background Unless substantial gains are made in the prevention of road crashes, they will become the third ranked global burden of disease and injury by 2020. A growing proportion of this burden relates to vulnerable road users (e.g., motorcyclists, cyclists, and pedestrians). In order to reduce this burden, there is a need to fully understand the nature and contributing circumstances of crashes and the resulting injuries. While police-reported crash data contain detailed information about crash circumstances, they lack accurate information about the severity and nature of injuries which are included in hospital data. By bringing these data collections together using data linkage, the relationship between the characteristics of vulnerable road user crashes and their resulting injuries were explored. Methods Data from the Queensland Road Crash Database (QRCD) and the Queensland Hospital Admitted Patients Data Collection (QHAPDC) for the year 2010 were linked. There were 1,382 police-reported motorcyclist injuries that linked to a hospital record (42% of all police-reported motorcyclist injuries), 429 cyclists (25%), and 644 (39%) pedestrians. The relationships between crash characteristics such as counterpart involvement, alcohol, fatigue, speed, and helmet use and injury severity (e.g., ICD-derived Injury Severity Score ICISS, length of stay), nature, and body region were examined. Results The involvement of motor vehicles was related to more severe injury outcomes for vulnerable road users (between 1.5 and 2.8 times the odds of being serious), as were high speeds (between 1.2 and 1.6 times), alcohol (2.1 times for motorcycles), and helmet non-use (between 1.9 and 2 times). The circumstances of crashes, such as counterpart type and crash location, influenced injury nature and body region. Conclusions By bringing together circumstance data from police and injury outcome data from hospitals, a greater understanding of the link between crash circumstances and injury outcomes was achieved. Studies using linked data can better inform intervention and treatment for a more holistic approach to the reduction of road trauma for vulnerable road users.

Background To reduce road trauma we must better understand the factors contributing to crashes. In Queensland, Australia, rear end crashes are the 3rd leading crash type, with mild to serious injuries a likely outcome and whiplash a common injury occurrence. Road design, traffic congestion, and weather/road conditions have been implicated in rear end crashes. Human factors also play a key role, with the act of ‘following too closely’ being a major issue. Queensland legislation requires motorists to maintain a safe following distance between their vehicle and the one in front, although no specific information about this distance is prescribed by law for cars. Methods To better understand perceptions of safe following distance, 495 licensed Queensland drivers (42% male; mean age 46.2 yrs; range 16–81 yrs) completed an online questionnaire. Results Overall, there was wide variation in descriptions of safe following distance including time between vehicles (2 seconds = 21%; 3 seconds = 11%), distance between vehicles (metres = 11%; car lengths = 32%); and combinations of time and distance (1%). No one reported having received an infringement for not keeping a safe following distance, although 29% reported being involved in a crash where their vehicle hit the one in front. The majority (86%) reported that it was somewhat-extremely unlikely they would be caught by police if following too closely, indicating a perceived lack of enforcement for this offence. Reasons for this included perceptions of difficulty for police to enforce this offence (5%), not having heard of anyone being caught for this offence (17%), and other police priorities (30%). Conclusions This study is part of a larger research project that aims to improve knowledge about driving conditions, patterns and locations, and driver behaviours that lead to driving at unsafe headways (i.e. following too closely). Recommendations for use of these findings to inform driver education and awareness campaigns are discussed.

This study identified the areas of poor specificity in national injury hospitalization data and the areas of improvement and deterioration in specificity over time. A descriptive analysis of 10 years of national hospital discharge data for Australia from July 2002–June 2012 was performed. Proportions and percentage change of defined/undefined codes over time was examined. At the intent block level, accidents and assault were the most poorly defined with over 11% undefined in each block. The mechanism blocks for accidents showed a significant deterioration in specificity over time with up to 20% more undefined codes in some mechanisms. Place and activity were poorly defined at the broad block level (43% and 72% undefined respectively). Private hospitals and hospitals in very remote locations recorded the highest proportion of undefined codes. Those aged over 60 years and females had the higher proportion of undefined code usage. This study has identified significant, and worsening, deficiencies in the specificity of coded injury data in several areas. Focal attention is needed to improve the quality of injury data, especially on those identified in this study, to provide the evidence base needed to address the significant burden of injury in the Australian community.

Objective: Using a pre-test/post-test quasi-experimental study in two New Hampshire ICUs, the impact of daylight and window views on patient pain levels, length of stay, staff errors, absenteeism, and vacancy rates were examined. One ICU was operational until 2007, the second opened in 2007. ICU patients were randomly selected from cardiac surgery, pneumonia, and chronic obstructive pulmonary disease admissions of one or more days, 58 from the old ICU, and 52 from the new. Regular medical staff members assigned to the unit between October 2006 and September 2007 (old unit) and March 2008 and February 2009 (new unit) were included. Results: Variables other than unit design had a more significant impact on relative pain levels in each unit. Comparing light levels independent of ICU assignment supported the hypothesis that increased light levels reduce pain perception and length of stay, but the relationship was not statistically significant. One trend, not statistically significant, suggested that view was associated with reduced pain perception. A decrease in incident filings supported the hypothesis that improved natural light and views reduced errors, but results were not statistically significant. Some subcategories demonstrated significance. Mean absenteeism per person decreased from 38 to 23 hours from the old unit to the new (p = 0.05). Average vacancy rates decreased by 25% (from 10.12% to 7.49% staff openings per year) in the old and new units (p = 0.04). Conclusion: High levels of natural light and window views may positively affect staff absenteeism and staff vacancy. Factors such as medical errors, patient pain, and length of stay require additional research.

Healthcare facilities are the most complex and mutable of all building types, and enhanced collaboration between medical professionals and designers in facility research is needed. Architects have long been aware of this need and sought information from medical staff. Recently, they have supplemented this information by utilising data from research addressing the impact of the physical environment. The number of studies in this new field, however, is limited due in part to the lack of champions working within healthcare environments to facilitate and participate in the activities of design researchers. The process of using research in the design of environments has been labelled ‘evidence-based design’ (EBD), a term that came into use in the 1990s inspired by ‘evidence-based medicine’. EBD seeks to inform design decisions in order to make the resulting building maximally appropriate for the occupants. While several healthcare organisations have recognised the importance of using research in the design process, few entities have formally committed staff to gather data on this topic. As a result, designers are expanding their practices to incorporate EBD techniques without the benefit of medical staff to enhance the quality of the process. So strong is the belief that evidence is critical to good design, an organisation has generated an examination process (Evidence-based Design Accreditation and Certification) to credential designers and other professionals. Regarding healthcare in particular, environmental psychologists now confirm what medical professionals have always known—the physical environment has an impact on staff, patient and family outcomes. Of the array of issues …

Because nosocomial infection rates vary by hospital area and service, most infection control programs calculate area-specific rates to augment the reporting of their hospital-wide data. Rate development is often limited by the availability of appropriate specific denominator data to support important comparisons. Our university hospital reports a 20 month experience in which numerator data was collected as per the National Nosocomial Infections Surveillance System criteria for hospital-wide, high-risk nursery and ICU surveillance. These data were then combined with data in our hospital's patient-specific denominator file. This has enabled the development of risk-specific infection rates based on the analytic control of important variables available in both the numerator and denominator files. We found rate differences that were length of stay cohort specific, hospital day specific, age specific, birthweight specific, and survival cohort specific when examining our data by both the cumulative incidence and incidence density methods.