The Impact of Built and Ambient Hospital Ward Design on Clinical Care and Adverse Outcomes in Adults, Including Geriatric Inpatients: A Hybrid Umbrella–Systematic Review

Built and ambient features of hospital ward design may influence patient safety and inform future hospital construction and refurbishment. However, evidence on their overall impact remains fragmented. This review synthesised available evidence and highlighted key differences from previous reviews. A comprehensive search identified studies published between 1993 and 2023 involving hospital inpatients. Data were extracted from eligible systematic reviews and subsequently from cited primary studies to synthesise findings and address inconsistencies. Meta-analyses and effect size calculations were performed where appropriate. A total of 31 reviews and 50 primary studies were included. Fall outcomes mainly involved geriatric patients, while infection and delirium outcomes were derived from mixed adult populations. Compared with multi-bedrooms, single-patient rooms were associated with increased fall rates and numbers of fallers, but a lower proportion of patients and rates of hospital-acquired infection and delirium. Natural light and vinyl flooring showed non-significant trends toward reduced delirium and fewer fallers, respectively. Vinyl flooring was associated with higher injurious fall rates. Certainty of evidence was low to very low. Hospital ward design may substantially affect patient safety and quality of care, particularly for older adults. However, effects may be favourable or unfavourable depending on the outcome considered. Further empirical and economic research is needed to balance these competing outcomes.