ICU Case Study Analysis Notes

Introduction

• Focus on the Intensive Care Unit (ICU) design.
• Topics to cover: history of patient care, ICU users, current influences, space drivers, and case studies.

Fundamentals of Critical Care Design

History of ICU

• Florence Nightingale: Pioneered design principles for patient care units from battlefield experiences.
  • Emphasized visibility and airflow in patient rooms.
• Dr. Bjorn Ibsen: Introduced positive pressure ventilation (1952) in Copenhagen, leading to modern critical care practices.
• First ICU established in Denmark (1950s), then in the US (1962).
  • Growth of mechanical ventilation protocols and establishment of Society of Critical Care Medicine (1970).

ICU Users

• Patients and Families: Require ongoing specialized care and emotional support.
• Caregivers: Includes intensivists, specialized nurses, respiratory therapists, and family members.
  • Care dynamics are evolving to include family as active participants in care.

Current Influences on ICU Design

• Shortage of Healthcare Providers: Increased reliance on physician assistants and other support staff.
• Aging Population: Higher demand for critical care services.
• Facility Renovation Needs: Many older facilities require updates.
• Infection Control: Increased focus on cleanable environments due to drug-resistant bacteria and hospital-acquired infections.
• Technology Evolution: Constant advancements in monitoring and equipment technology.
• Healthcare Reform Legislation: Changes in reimbursement practices related to hospital-acquired infections and readmissions.

Space Drivers of ICU Design

Key Design Factors

• Hospital Adjacencies: ICU should be near surgical environments and emergency departments for efficient patient transfer.
• Operations: Nursing ratios typically 1:2 in ICU; decentralized nursing models are becoming more common.
• Regulatory Requirements: Compliance with AIA and FGI guidelines for space and clearance requirements.
• Equipment and Technology Needs: Consideration of medical gases, power, and acoustic management for patient comfort and safety.

Case Studies of ICU Designs

Types of ICU Units

1. Centralized Model: Nursing station at the center providing visibility to multiple patients.
2. Decentralized Model: Nursing stations spaced between patient rooms for better patient monitoring.
3. Hybrid Model: Combination of centralized and decentralized models, maintaining visibility with efficiency.

Case Study Examples

1. Swedish American Heart and Vascular Tower (Rockford, IL)

   • Centralized nursing model; visibility maximized; support spaces strategically placed.
   • Family space integrated into the design.

2. Saint Joseph's Hospital (Phoenix, AZ)

   • Decentralized model; includes satellite pharmacy and blood gas lab.
   • Emphasis on isolation rooms for infection control.
   • Column design utilized for patient rooms.

3. Rush University Medical Center

   • Large floor plan accommodating a high number of beds.
   • Separate circulation paths for staff and visitors.
   • Family spaces emphasized throughout the unit.

4. Ronald Reagan UCLA Medical Center

   • Hybrid model with both centralized and decentralized elements.
   • Boom room design for efficient access to patient care.
   • Innovation in room configurations for patient privacy and staff access.

Future Trends in ICU Design

• Sicker Patients: Increasing complexity of care required.
• Operational Efficiency: Enhanced focus on team-based care and efficiency due to staffing shortages.
• Technological Innovations: Potential for AI, nanotechnology, and robotics to reshape patient monitoring and care delivery.
• Integration of Medical Devices: Improved interoperability among devices to streamline patient care.

Conclusion

• ICU design continues to evolve in response to changing needs, technology advancements, and regulatory requirements.
• Emphasis on creating environments that support both patient care and caregiver efficiency.