A slight uptick in hospital construction is likely this year, based on results of an annual survey by H&HN's sister publication Health Facilities Management and the American Society for Healthcare Engineering, as well as interviews with industry insiders.

However, the volume of new construction remains down from 2008's high-water mark, many projects still are being deferred, and spending plans are being subjected to tough scrutiny. No true building bust has followed the boom, thanks to all the work that already was in progress. Access to capital is im­proving. But organizations are loath to resume old spending habits in the face of broad uncertainty about the changing nature of health care, not just the slow economic recovery.

The frugality hasn't halted the movement toward making patient rooms more like hotel rooms. The most popular features include such amenities as wireless technologies, individual room temperature control, larger room size, patient entertainment and educational systems, and in-room family areas. At hospitals nationwide, about a third of new rooms are incorporating these amenities.

Some softer features, such as views of nature, increased exposure to natural light and auditory environment controls to mitigate noise, have fallen out of favor for more cost-conscious measures since the recession began, the poll shows.

"Technology in the room, and the capability to bring in customized technology for things like PlayStation, are the norm now," says Mark Kenneday, vice chancellor for campus operations at the University of Arkansas for Medical Sciences in Little Rock. His organization made patient focus a priority in a recently completed bed tower, adding a wireless network with guest access in all new rooms, which are 260 to 300 square feet—large enough to allow a family member to stay and work.

Wireless technologies for hospital staff topped the list of features most often incorporated for safety purposes for the fifth consecutive year of the survey. Next were computerized provider order entry, in-room sinks, patient lifts and bar coding for medication administration.

Fletcher Allen Health Care in Burlington, Vt., will install terminals in patient rooms in its planned patient-bed replacement building, in keeping with its shift to electronic health records, while still retaining the option for nursing staff to bring in mobile terminals. "Part of the reason for going both those ways is there's a lot of individual preference among clinicians," says David Keelty, director of facilities planning and development.

Room size may have peaked as organizations focus more on cost-effective design, says Joseph Sprague, senior vice president and director of health facilities at HKS Architects in Dallas. "Every hospital is trying to get as much either reduced cost or increased efficiency out of their design, because they're being asked to do more with less," he says.

Among design features to improve quality, multiple locations for hand washing or sanitizing topped survey respondents' list for the third straight year. Next were decentralized nurses' stations and added air treatment or air movement capacity.