Last week's show was all about the impact of design of hospitals and medical equipment on your health, your safety and your life.  This is an issue that we think is important to follow because of its potential effect on you.  Evidently, by your many emails and comments, you agree.

Many of you reacted to me fumbling around with a computer-controlled intravenous infusion pump.  These pumps are used in hospitals right across Canada to administer everything from narcotic pain relievers to antibiotics to cancer chemotherapy. 

Tony Roberts of St. Anthony sent us this:  "Living in a hospital town I visit the hospital very often, and one thing I learned is that 98% of nurses cannot set up AND especially run an infusion pump.  I've seen it over & over again...year after year. Recently, when my friend's father was in the hospital, he took over running his own infusion pump, he was that sick of the alarm going off all the time and sick of watching the nurses trying to keep the pump running."

Some of you felt motivated to rush to the defence of nurses.  Andrea Schmaltz of Ottawa writes:  "As a critical care nurse of 20 years, I thoroughly appreciate the challenges of technology and the risk of error.  It is an important topic and I encourage discussion regarding the topic.  My issue is with the CBC promo prior to the program.  The choice of language seemed to convey that IV pumps were too complicated for nurses.  For someone listening to the entire program they could situate the comment within the full story.  However, for others who only heard the sound bite, it may generate some unnecessary fear among the public.  Nurses make mistakes.  My worry is that statements such as IV pumps are too complicated for nurses might do two things: (1) insinuate that nurses are somehow not academically/technologically sophisticated enough for sophisticated equipment; and (2) that technology and error is solely a nursing issue.  Given that the majority of patients admitted to acute care settings have an IV pump managed by a nurse, what is the listener to do with this information?"

Fair points, Andrea.  However, I hope the following example will reassure you at least somewhat.  The airline industry is considered far ahead of health care in developing a culture of safety.  It wasn't always that way.  Decades ago, airline accident rates began to climb, prompting engineers to search for solutions.  They came to the conclusion that a major factor in rising accident rates was the increasingly complex array of instruments in aircraft cockpits.  It would have been very easy for engineers to conclude that pilots weren't smart enough to operate modern aircraft.  Instead, human factors engineers were called in to redesign cockpits to make flying easier for pilots. 

The analogy with respect to nurses and IV infusion pumps couldn't be clearer.  No one is suggesting that nurses or anyone else who programs and operates infusion pumps lack the intelligence to operate them.  Instead, as manufacturers have piled on more and more features, infusion pumps have become more complex and less intuitive to operate.  That's a design issue, not one of human resources.

Many of you commented on the impact of hospital design on the quality of health care 

Claire Hilscher of Bowser, British Columbia writes:  "I have been a laboratory technologist for 25+ years, and now I am a dept manager.  My first hospital job was at a newly built hospital in Calgary.  The design of that building, and our lab department, was far superior to anything I have experienced since then.  The job of providing excellent service was made much easier by our proximity to the Emergency Department and the Intensive Care Unit.  The Operating Room was across the hall from the blood bank.  All of these are common sense design features.  The building also "felt" good.  The temperatures were controllable.  The air felt reasonably fresh, and the architects took advantage of natural light and views of the nearby water from patient rooms. Most importantly, the design made it safe for staff and patients."

Jenny Take sent us this:  "Unfortunately, it seems that the architects in Toronto that you featured and you see patient and staff safety as the number one design concern out of a presupposition that clients can be violent and dangerous.  This reinforces the stigma that psychiatric clients tend to be violent and dangerous. This is just not so.  People who designed psychiatric hospital facilities where I live in the Maritimes did not spend time scratching their heads trying how to build "safe" wards because it was and is not necessary. They just built them like ordinary wards.  Despite the lack of 'safe' design, everyone here is quite safe on the units."