PIEDMONT HOSPITAL ICUsA visit to Red (Open Heart CCU), Green (NICU), and Blue Units (Med Surg.)

with a comparison to a Regular Hospital Room

Host: Patricia BlackGroup Members: Wanlin Xiang, Siming Mao, Ann Rogers, Kushal Waghmare

ICU Blue

• Configured for maximum storage of supplies both within patient room and outside

• Sleeping discouraged (no family area)• Quiet• Ample ambulatory space for nurses

ICU Green

• Cited by Ms. Black as more problematic than rectangular layout due to difficulty in aligning rectilinear furniture

• Observed by team members: • Less space for nurse alcoves• More restricted ambulatory space• Disorienting

ICU Red

• Open Heart (CCU)• Same layout as ICU Blue• 10 rooms instead of 12

Regular Patient Room• No Visibility• Inboard toilet in the room• Large window >> More natural light• Difficult to renovate: Wiring embedded in concrete walls make

rewiring difficult• Expensive glass doors

Problems at Piedmont noted by Ms. Black

• Monitoring:• Too many machines to nurse: “I’d rather be talking to them

or washing their hair, etc.” – Charting:

• Too much time spent charting• Charting often done long after observations are made• Charting done on hands

– Nurses don’t want to spend as much time in the room as Ms. Black wants them to.

• Family inclusion versus intrusion• Technologies don’t “talk” to one another• Building is land-locked, so expansion is difficult• Noise of TVs

Problems our group will focus on:“Design for better visibility”

1. “Retrofit Visibility” -- It is difficult and expensive to renovate existing designs– For ICUs (circle layout)– Non-ICUs being renovated to become ICUs

2. “Family Inclusion v. Intrusion” -- The hospital desires to include families in the care process but they interrupt nurse workflow and make them uncomfortable to be observed (causing pain to the patient, e.g.)

Problems our group will focus on:“Design for better visibility”

3. “Face Time” -- Nurses don’t get to spend as much time in direct contact with the patient as is desired

1. Because of charting difficulties2. Because of the profusion of machines

Problems our group will focus on:“Design for better visibility”

Ideas for solutions:

Problem 1: “Retrofit Visibility”

• Reduction in the number of rooms ICU Green (Piedmont): Originally had 10 rooms, which were reduced to 8

• Using Cameras, Mirrors• Outboard toilets and less storage in the room• More glass windows• Normalizing the round layout…

…Normalizing the round layout

Bathroom

FamilyStorage

*Depends on available space

Ideas for Solutions:

Problem 2: “Family Inclusion v. Intrusion”

• Headphones• Lighted nametag color-coded to indicate

availability

Ideas for solutions:

Problem 3: “Face Time”

• Exterior wall-mounted display with touch-screen representation of patient body, for entering charting information

• Shoulder-mounted audio recording device with speech recognition software

• Automated Charting done by equipment

Children's Healthcare of Atlanta at Scottish Rite

Neonatal Intensive Care Unit

Special layout under limited space

visual isolationdifferent color

zones

visual isolationdifferent color

zones

physical isolation

clapboard

physical isolation

clapboard

Layout in single unit-group

Patient Bed

Working Table

Working Table

Family Sofa

Swivel Chair

Visual isolationColored

patient zonePhysical isolation

Visual isolation

Storage

• Visibility when nurses are working at working tables

Problem Identified

Field Observation

Proposed Solution• Change of layout in unit to allow for better

visibility

StorageFor things not used all

the time

Before After

Other Problems and Current Solutions

Visual isolation is a kind of virtual isolation.• Noise: noise suppression• Infection: negative air pressure• Family visiting: leave enough distance• …

Could there be better solutions?

Thank you