Institutional members access full text with Ovid®

Share this article on:

Do Windows or Natural Views Affect Outcomes or Costs Among Patients in ICUs?

Kohn, Rachel MD1; Harhay, Michael O. MPH, MBE2,3; Cooney, Elizabeth MPH2,3; Small, Dylan S. PhD4; Halpern, Scott D. MD, PhD2,3,5,6

doi: 10.1097/CCM.0b013e318287f6cb
Clinical Investigations

Objective: To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients.

Design: Retrospective cohort study.

Setting: An academic hospital in Philadelphia, PA.

Patients: Six thousand one hundred thirty-eight patients admitted to a 24-bed medical ICU and 6,631 patients admitted to a 24-bed surgical ICU from July 1, 2006, to June 30, 2010.

Interventions: Assignment to medical ICU rooms with vs. without windows and to surgical ICU rooms with natural vs. industrial views based on bed availability.

Measurements and Main Results: In primary analyses adjusting for patient characteristics, medical ICU patients admitted to rooms with (n = 4,093) versus without (n = 2,243) windows did not differ in rates of ICU (p = 0.25) or in-hospital (p = 0.94) mortality, ICU readmissions (p = 0.37), or delirium (p = 0.56). Surgical ICU patients admitted to rooms with natural (n = 3,072) versus industrial (n = 3,588) views experienced slightly shorter ICU lengths of stay and slightly lower variable costs. Instrumental variable analyses based on initial bed assignment and exposure time did not show any differences in any outcomes in either the medical ICU or surgical ICU cohorts, and none of the differences noted in primary analyses remained statistically significant when adjusting for multiple comparisons. In a prespecified subgroup analysis among patients with ICU length of stay greater than 72 hours, MICU windows were associated with reduced ICU (p = 0.02) and hospital mortality (p = 0.04); these results did not meet criteria for significance after adjustment for multiple comparisons.

Conclusions: ICU rooms with windows or natural views do not improve outcomes or reduce costs of in-hospital care for general populations of medical and surgical ICU patients. Future work is needed to determine whether targeting light from windows directly toward patients influences outcomes and to explore these effects in patients at high risk for adverse outcomes.

Supplemental Digital Content is available in the text.

1Department of Medicine, Massachusetts General Hospital, Boston, MA.

2Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA.

3 Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia, PA.

4 Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA.

5 Division of Pulmonology, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

6 Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Dr. Halpern had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Dr. Halpern was supported by K08 HS018406 from the Agency for Healthcare Research and Quality. This sponsor had no role in the design or conduct of the study, in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr. Halpern has grants pending with the National Institute of Aging, Greenwall Foundation, Otta Haas Charitable Trust, University of Michigan, and University of Pennsylvania Center for Excellence in Cancer Communication Res, funding from NIH. Dr. Kohn received funding from the Agency for Healthcare Research and Quality. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail:

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins