Rethinking the intensive care unit

Intensive care units (ICUs) have the highest mortality rates in the healthcare system. Although this is partly because ICUs have the sickest patients, other problems contribute to a mortality rate that is higher than it should be. ICUs have long been chronically understaffed and chaotic. ICUs often have insufficient technology for staff to communicate effectively with each other. ICU experience is traumatic for a patient’s family, which has traditionally been barred for all but a couple of hours per day and given minimal information and support.

Key Planning Areas

The utilization of ICU rooms rose at Guam Memorial Hospital by 11 % to just under 500 admissions. Assuming an average length of stay of 7 days and a target occupancy ratio of 90% GMH should have 11 rooms for current patient load. Careful consideration needs to be given at the initial design session to projected patient admits in the future and area required to meet this volume over time.

Patient Room
The layout of traditional ICU is characterized by large easily accessible patient rooms that are grouped so each patient is visible from a central nurse station with supplies and support services close at hand. Patient toilet/shower rooms are typically not provided for each patient room in an intensive care unit since these patients are not generally ambulatory due to their acuity.

Many institutions are designing around nurse workstations that are located immediately outside the patient room and provide better visualization and monitoring than a central station.

Family and Visitor
Newer rooms have been sized to allow for the patient’s family to be present on a 24 hour basis. Consideration for accommodating space and amenities for them is required.

Room Utilization – Relationship to Patient Care Units – Acuity Adaptable

Acuity- adaptable patient rooms where staffing and equipment can be readily adjusted to meet the needs of patients thereby eliminating unnecessary transfers, overstaffing and excessive treatment base on ICU protocols. Instead critically ill patients, regardless of their location within the hospital, would be monitored remotely using telepresence.

Clinical Documentation

If the nurse workstation is located at the room, then a “nurse server” would be required for charting, staff shift change and interaction with other medical staff providers.

Security in ICUs is often about limiting visitors and other disruptions to the patient.

Patient Visitor Amenities
Of necessity ICUs are clinical spaces and utilize lots of medical equipment. Use of booms to locate these devices out of the line-of-sight for patients is essential. Walls at the patient foot should provide for information that a patient may seek as they cycle through wake/sleep events. Items such as time of day, day of week, clinical staff names should be readily apparent. Space for cards and other items that support the patient connection to family and friends need to incorporated. Finally a view of nature is not only required, it is essential to the healing process.

Clinical Support
As units grow and technology changes, the ratios of support space required has also grown. The locations of support spaces need to be carefully considered to optimize the flow of supplies, and staff.

Network Infrastructure

Remote patient management of critically-ill patients is being successfully implemented. CKA’s recent experience in working with Swedish Medical Center in implementing space for interventionists to monitor 3 hospital units via telepresence.


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