Should an Adult Hospital Act and Feel More Like a Pediatric Hospital?

PHILADELPHIA — An opinion piece in this week’s JAMA from Penn Medicine fourth-year medical student Mark Attiah suggests that if adult hospitals were modeled more closely after children’s hospitals—from the paint color to practice patterns—they may improve patient quality of life, satisfaction and even health outcomes.

“Adult hospitals, as they begin to fully realize the importance of the environment to a vulnerable patient’s well-being, can take a page from the pediatric playbook by creating surroundings that distract and reduce stress, and by making clinical practices more patient and family-oriented rather than more convenient for the caretakers,” said Attiah, who wrote the piece titled “Treat me Like a Child,” which recounts his experiences with two pediatric patients during a pediatrics rotation and another who transitioned into an adult hospital to tell this story.

White coats were noticeably absent during that rotation. It was bright. They had longer visiting hours, with rooms where families could stay at patients’ bedside through the night. And there were distractions left and right: group activities, concerts, etc.  “If I ever get sick, I’d want to be taken here,” he writes.  There is strong data that shows better patient environments can improve outcomes, the piece notes.

But it goes beyond surroundings. Attiah notes that there is a difference in the approach to care. “There’s an assumption that adult patients have developed a certain hardiness, a stiff upper lip that renders a reasonably pleasant environment or even sometimes a complete patient-physician trust unnecessary,” he argues. With that, physicians approach adult patients as seasoned veterans who are able to cope with the hardships of being ill in an alien environment with relative ease, even though this is often untrue.

“The truth is that without help, most people, regardless of their age, aren’t naturally good at being patients,” he writes.  Could approaching the patient with this mindset actually the make the experience more tolerable?
Also, at a children’s hospital, families are almost always involved in codes (emergency procedures) and even call codes themselves—which is not a common occurrence in adult hospitals.  This, he argues, implies that the patients’ families are not equal parts of the health care team and that the physician’s comfort is more important than the peace of mind of concerned family members. (Interestingly, a multicenter trial found that families present during codes doesn’t increase lawsuits or interfere with medical efforts, Attiah points out.)

“This is not a call to place a large teddy bear in every hospital bed and a bounce house in every lobby,” Attiah writes. “We do, however, need to recognize that the environment, the practice patterns, and the mission of a hospital make a direct difference in patient care that can be measured not only in smiles and thank-you notes, but tangible patient outcomes that even hospital administrators can get behind.”


Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.