title: On the Planning and Design of Hospital Circulation Zones.
abstract: OBJECTIVE
  This present literature review explores current issues and research inconsistencies regarding the design of hospital circulation zones and the associated health-related outcomes.
  
  
  BACKGROUND
  Large general hospitals are immense, highly sophisticated institutions. Empirical studies have indicated excessively institutional environments in large medical centers are a cause of negative effects to occupants, including stress, anxiety, wayfinding difficulties and spatial disorientation, lack of cognitional control, and stress associated with inadequate access to nature. The rise of patient-centered and evidence-based movements in healthcare planning and design has resulted in a general rise in the quality of hospital physical environments. However, as a core component of any healthcare delivery system, hospital circulation zones have tended to remain neglected within the comparatively broad palette of research conducted and reported to date.
  
  
  METHODS
  A systematic literature review was conducted based upon combinations of key words developed vis-à-vis a literature search in 11 major databases in the realm of the health sciences and the planning and design of built environments for healthcare.
  
  
  RESULTS
  Eleven peer-reviewed articles were included in the analysis. Six research themes were identified according to associated health-related outcomes, including wayfinding difficulties and spatial disorientation, communication and socialization patterns, measures and control of excessive noise, patient fall incidents, and occupants' stress and satisfaction levels.
  
  
  CONCLUSIONS
  Several knowledge gaps as well as commonalities in the pertinent research literature were identified. Perhaps the overriding finding is that occupants' meaningful exposure to views of nature from within hospital circulation zones can potentially enhance wayfinding and spatial navigation. Future research priories on this subject are discussed.
authors.affiliation: 1 School of Design and Community Development, West Virginia University, Morgantown, WV, USA.
authors.forename: Shan
authors.initials: S
authors.lastname: Jiang
authors.affiliation: 2 John H. Daniels Faculty of Architecture, Landscape and Design, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Verderber
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D003142:Communication; D004779:Environment Design; D006272:Health Facility Environment; D006749:Hospital Design and Construction / Q000379:methods* / Q000592:standards; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D009622:Noise / Q000517:prevention & control; D000072458:Orientation, Spatial; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology; D012951:Socialization; D013315:Stress, Psychological
keywords: circulation zones; evidence-based design; health outcomes; hospitals; patient-centered care; systematic literature review