icu design

4/28/2010

1

Outline

• Percentage of ICU beds to the hospital beds.

• Location of ICU

• Relationship of ICU design and mortality.

What do you look for in your ICU design?• What do you look for in your ICU design?

4/28/2010

2

ICU Design

• Evolution of Critical CareEvolution of Critical Care

• Critical Care and the Pressure

• Funding of Critical Care

• Value of Money

• Additional life save VS Additional Survivor of hypercholesterolaemia

45000$ 250000$

BMJ 1999

ICU Design

4/28/2010

3

Modern ICU

Team meeting

4/28/2010

4

Things to discuss• No. of beds in ICU

• Location of the ICU• Location of the ICU

• Physical Design

• Room size

• ICU environment

• Information technology

• Other facilities (offices, on call rooms, storages,

waiting area, staff lounge area).

Correlation of No. of ICU Bed with No. of Hospital Stay

No. of days permonth with

No. of days per month

month withmore than 1unoccupied bed

No of days per

No. of transfers per month (Safety parameter)

Minimisation of both the mean and the SD

Nguyen, J. M. et. Al. Intensive Care Med (2003) 29:849–852

y pwith more than 2unoccupied beds(efficiency parameter)

No. of days per month with a full unit (accessibility parameter)

4/28/2010

5

Correlation of No. of ICU Bed with No. of Hospital Stay

Nguyen, J. M. et. Al. Intensive Care Med (2003) 29:849–852

Adult Critical Care services for 8 countries

Adult ICU Beds/ 100,000 Population

Adult ICU Beds as % of All Acute Care

Hospital Bedsp

US 20.0 (2004 / 2005) 9.0 (2004)

France 9.3 2.5

UK 3.5 (2003 - 2005) 1.2 (2003 - 2005)

Canada 13.5 3.4

Belgium 21.9 4.4

Wunsh, Hannah et. Al. Crit Care Med 2008 Vol. 36, No. 10

Germany 24.6 4.1

Netherlands 8.4 2.8

Spain 8.2 2.5

Saudi Arabia 3.5 - 5.5

4/28/2010

6

Correlation between intensive care unit beds per 100,000 population and healthcare spending per capita in eight countries.


Correlation between intensive care unit beds per 100,000 population and hospital mortality for intensive care unit patients.


4/28/2010

7

ICU Location

ORRehab Medicine

ICU

Engineering

Laboratory

Ward ER

Engineering IT

RadiologyDischarge

Physical Design

• ICUs with 5 – 6 beds are inefficient to operate and manage.

• ICUs more than 10 beds would be difficult to design and manage.

Reference : King Khalid University Hospital

4/28/2010

8

Physical Design

• ICU with more than 10 beds to be broken down into pods or cluster of at least 7 beds

per pod.

Relationship between ICU design and mortality.

Leaf, David et. al. CHEST. January 2010, Pg. 22

4/28/2010

9

Relationship between ICU design and mortality.

Hospital Mortality: Among patients with APACHE II scores > 30.

Leaf, David et. al. CHEST. January 2010, Pg. 21

Room Size

window

• Allow staff access to patient.

• Easy to maneuver patient and equipment.y p q p

• Space to accommodate clinical equipment.

• Space to accommodate mobile equipment.

• Sufficient space for 5 members of staff.

• Sufficient space for privacy and dignity.

• Sufficient space for patient’s chair.p p

• Sufficient space for 2 visitors.

4/28/2010

10

Pendants


Pendants


4/28/2010

11

Handwash Basin

• Designed to avoid splashing

Handwash Basin Requirements

Designed to avoid splashing

• Easy to clean

• Non touch taps

• Non touch soap dispenser

Source : M. D. Anderson Ambulatory Cancer Center Houston

Open Plan AreaADVANTAGES

• Increased visibility• Easier access to patients• Teamwork increased

DISADVANTAGES

N i

• Management easier• Stimulation for patients• Sense of security and support

for inexperienced staff

• Noisy• Busy environment• Scary environment • Decreased concentration• Sensory overload for patients

and staff.

4/28/2010

12

Single RoomsADVANTAGES

• patient satisfaction• Reduction of infection• Quieter, peaceful, private

DISADVANTAGES

• visibility and access to patients.

Q , p , p• Less sensory overload• Improved quality of sleep• Less anxiety

p• Difficult to manage• Decreased communication.• Less direct contact with

medical teams.• Nursing staff dissatisfaction

and anxiety.• Patient anxiety, boredom

and depression. Reference : www.jpshealthnet.org

NoiseStrategies for Noise REDUCTION

• Single room

• Double-glazed window sDouble glazed window s

• Silent methods of communication

(Telephone with light signal

instead of audible ring tone.)

• Clear glass screen

• Acoustically absorbent ceilings.


Acoustically absorbent ceilings.

• Wearing soft sole shoes for staff

and visitors.

4/28/2010

13

Lighting (Natural Lighting)

• Daylight has beneficial effects on patients, visitors and staff.

• It improves outcomes in patients, and increasing morale and reducing sickness

levels among staff. (Rubin & Owens, 1996).


Lighting (Natural Lighting through WINDOWS)

• An outdoor view is beneficial, even though it is limited.

Reference : www.jpshealthnet.org

4/28/2010

14

Lighting (Natural Lighting through WINDOWS)

Requirements for Requirements for

WINDOWS:WINDOWS:

Double-glazed

With “Blackout”

Easy to clean

Non-openable

Insulation against noise

P t l Prevents glare

Provides visual link to the

outside but does not

compromise patients privacy.

Good positioning to avoid high

glare at midday.Reference : NHS Estates, HBN 57

Lighting

4/28/2010

15

Ceiling

Ceiling Materials

• Acoustically absorbent material to decrease noise.• Minimizes the gathering of micro-organisms.• Ventilation grills are easy to clean and not located over the bed space.• Ceilings for single bedrooms should be SEALED.

Source : St. David’s Health Resource Center

FlooringFloor finishing

• Smooth

• Crack free

• Stable

• Easy to clean

• Slip resistant

• Withstand harsh treatment

• rolling of heavy mobile equipments

• regular hard cleaning.


• Wear-resistant flooring material• Adhesive should be powerful

enough to withstand formation of “waves” that can be a result from moving of heavy mobile equipments.

4/28/2010

16

ICU Design


Nursing Station


4/28/2010

17

Offices, Family Counseling Room Visitors Area, Seminar Room

Nursing Staff lounge and locker,Doctor’s On Call Room

4/28/2010

18

Support for Families and FriendsFamily Counseling

Room

• Must have a

d l di t door leading to

the MAIN

Corridor.

• Room décor

should convey

l d

Reference : Austin Clinic

calm and

comfort.

• Telephone

should be

provided.

Support for Families and FriendsSitting Room / Waiting Area

• Can accommodate several groups of visitors.• Comfortable seating• Décor should suggest calm and comfort.• Beverage making facilities and Television should be provided• Beverage making facilities and Television should be provided.• Have its own WC.

Reference : Brackenridge Intensive Care Unit

4/28/2010

19

Conclusion

Knowledge of critical care needs is essential.

Future ICU Design should be spacious, environmental

friendly, safe, patient centered and technically sound.

icu design

Documents