ICU Tours

Temi Yembra, Sarah Manning, Stephanie Allen, Sukanya Bhattacharya, Surabhi Satam, and Kruti Shah

Piedmont Hospital

There were 5 ICUs

ICU Green• Built in 1970• Medical surgical ICU• Very small rooms with odd angles

Round shaped ICU with central nurse stationAdvantages: Visibility into all roomsDisadvantage: Not enough movement space for equipment and furniture.

Piedmont Hospital

ICU Blue• Medical, surgical ICU -  

      built 5 years ago• 12 bed ICU • Moderate room size• No provision for family accommodation• Room monitors are connected with the Central mother

monitor 

ICU Red• Open heart ICU

Piedmont Hospital

5 East ICU

• Newly built about 2,3 years ago• 10 beds ICU - small rooms

Stepdown Unit

• Converted general patient rooms in ICU • Total 9 beds and rooms are very small• Nurse station is far 

Disadvantage - visualization problem

General Information

Visitation is open except during hand-off 

Nurses    12 hour shifts    1:1 or 1:2 depending on patient condition

Physicians in ICU

• Intensivists - Who specializes in the care of critically ill patients, mostly in ICU.

• Extenders – Expert physicians or nurses that replace experienced doctors in the ICU in the midnight to early morning shift.

Problem - Clinical Documentation

Changed to electronic 7 years ago

Physician and progress notes still on paper

Electronic medical records do not all talk to each other

Solution - Clinical Documentation

Develop a software to integrate medical records

   -  Within the hospital       -  Ability to access records from other hospitals            - Helps know what medication the patient is taking        

Problem - Patient Falls

Prevalent within men in their 50s - 60s

Side effects from getting up after receiving narcotics

Solution - Patient Falls

Created a falls protection program

Provide susceptible patients with green armbands to be recognized

If possible, place such patients in rooms with cameras

Follow checklists and protocol

Other problems

Size of ICUs    - Too many cabinets in rooms    - Converted from regular patient rooms

Most walls are concrete made which is a problem in    - Taking any new telephone line through walls    - Making changes in the present room size    

Scottish Rite

Average Staffing Ratio is 2 patients to 1 nurse Age Ranges of populations Served • Neonate, 30 days • Infant, 30 days to 1 year • Early Childhood, 1 year to 5 years • Late Childhood, 5 years to 13 years • Adolescent, 13 years to 17 years • Adult, 17+ years

 

Scottish Rite

• Neonatal ICU (NICU)o 35 beds (3 isolation rooms)o Pinwheel Designo Sterile and non-sterile areaso Typical healing time : 28 dayso Three types of alarms system

            - Orange: To call the nurse            - White :   Parents need help            - Blue :      Patient in crisis  

Scottish Rite

• Pediatric ICU (PICU)o 26 beds in 3 L-shaped Podso Private Rooms (helps reduce infection rate)o Overhead Boomo 3 separate entrances- 2 for staffs 1 for visitoro Typical healing time: 4 days

 

Problem - Privacy in NICU

• Open layout (see and hear activity in other patient areas)• No Visitors During Shift Changes (7am and 7pm• May discourage parents from staying at the bedside

  

Research Opportunities

• Best practices in communication• Alternative communication

o Mobile alertso Pagerso Online access to full/limited medical records

• NICU Layoutso Bowling Allyo Pinwheelo Private Rooms

Problem - Family Space in ICU

Overarching Issue:ALL patients must have a parent/guardian present to consent

NICU• Parents/Visitors typically sit in "hallway" area• There is very limited privacy for parents• Area not suited for overnight visits

o Alternatives NICU Family Waiting Area 7 Private Rooms Hospital-wide Ronald McDonald House

Problem - Family Space in ICU

PICU• One sleeper chair per room• No designated family area in

room• If in Pod 2 or 3 the travel to the

family waiting area is far  

Research Opportunity

• Effectiveness of layout in Rehab at Scottish Rite• Ample floor space• Designated Family Area• Allows for less strict visitation policy

• Effectiveness of family oriented-layout at other hospitals  

Research Opportunity

• Waiting Area Design and Amenitieso Seating Areao Sleeping Areao Eating Areao Secure Storageo Entertainment Area

• Paging/Locating System  

Problem - POUS in PICU

• Nurses and Respiratory Therapists frequently leave room to retrieve supplies

• RN comment: Visit OMNI Cell 20+ times per day

• OMNI cell is very far away for some pods

• RN loses visual when retrieving supplies

Research Opportunity

• Space in PICU ICU rooms allows more supply storage• Are carts being used effectively?• Are drawers and cabinets being used effectively?• What is the optimal par level of supplies in room?• What kinds of supplies are charged to the patient and

charged to the department?