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Design for Critical Care

SALUS TV Series – The Future Hospital: Critical Care 2050

January 26, 2022 / Dochitect / Design for Critical Care

Presentations

Event: The Future Hospital: Critical Care 2050
Date: January 26, 2022, 17.00–18.30 GMT

New “innovation” series on SALUS TV to explore the future hospital to 2050:

The pandemic has posed unprecedented challenges for healthcare, but it has also paved the way for transformational change in preparedness, response and recovery. Expandable and flexible bed and staffing capacities, safer ICU design, more effective triage, digital transformation and adoption of AI, and new approaches to communication with patients and families are all changing the way critical care services and facilities are being planned and designed. An expert panel will imagine what critical care medicine and the settings in which it is delivered will look like in the future.

Panel:

  • Chair: Tina Nolan, managing director, ETL; Health Planning Academy, UK;
  • Dr Ganesh Suntharalingam, intensivist, London North West University Healthcare; past president, Intensive Care Society, UK;
  • Dr Diana Anderson, dochitect, Jacobs; instructor of neurology, Boston University School of Medicine; geriatric neurology fellow, VA Boston, USA;
  • Dr Tom Best, clinical director of critical care, King’s College London, UK;
  • Dr Benjamin Bassin, associate professor, Emergency Medicine; director, Emergency Critical Care Center, Department of Emergency Medicine, University of Michigan Medical School, USA; and
  • Graeme Hall, executive chairman, Brandon Medical, UK.

Click HERE to learn more about the Future Hospital 5050 series.

Panel Discussions

Keeping a 2009 Design Award-Winning Intensive Care Unit Current: A 13-Year Case Study

May 26, 2020 / Dochitect / Design for Critical Care

Peer-reviewed publication

Publication: Health Environments Research and Design (HERD)
Publication Reference: 2020 May 26;1937586720918225. doi: 10.1177/1937586720918225. Online ahead of print.
Authors: Neil A Halpern, Diana C Anderson

Abstract

In a complex medical center environment, the occupants of newly built or renovated spaces expect everything to “function almost perfectly” immediately upon occupancy and for years to come. However, the reality is usually quite different. The need to remediate initial design deficiencies or problems not noted with simulated workflows may occur. In our intensive care unit (ICU), we were very committed to both short-term and long-term enhancements to improve the built and technological environments in order to correct design flaws and modernize the space to extend its operational life way beyond a decade. In this case study, we present all the improvements and their background in our 20-bed, adult medical-surgical ICU. This ICU was the recipient of the Society of Critical Care Medicine’s 2009 ICU Design Award Citation. Our discussion addresses redesign and repurposing of ICU and support spaces to accommodate expanding clinical or entirely new programs, new regulations and mandates; upgrading of new technologies and informatics platforms; introducing new design initiatives; and addressing wear and tear and gaps in security and disaster management. These initiatives were all implemented while our ICU remained fully operational. Proposals that could not be implemented are also discussed. We believe this case study describing our experiences and real-life approaches to analyzing and solving challenges in a dynamic environment may offer great value to architects, designers, critical care providers, and hospital administrators whether they are involved in initial ICU design or participate in long-term ICU redesign or modernization.

Keywords: architecture; critical care unit; design; intensive care unit; renovations.

Access the article HERE

Peer-Reviewed Publications

Intensive Care Unit Design: Current Standards and Future Trends

December 30, 2017 / Dochitect / Design for Critical Care

Book Chapter

Book Title: Irwin and Rippe’s Intensive Care Medicine, 8e
Book Editors: Richard S. Irwin, Craig M. Lilly, Paul H. Mayo and James M. Rippe
Publisher: Wolters Kluwer, 2017
Chapter Title: Intensive Care Unit Design: Current Standards and Future Trends
Chapter Authors:
Diana C. Anderson, Neil A. Halpern

Except: Hospital-based intensivist administrators at some point in their careers may be asked to participate in designing new or renovating existing ICUs. For simplicity of presentation we have divided this chapter into five sections; the ICU design process, the ICU patient room, central clinical, visitor and staff support and administrative areas, ICU informatics, and future trends. While we classify these areas separately, they are indeed heavily interrelated.

Healthcare and design are actually very complex processes that must accommodate and address continuously evolving guidelines and regulatory standards. Several core principles should guide ICU-specific design.

Link to Purchase Irwin and Rippe’s Intensive Care Medicine, 8e:

Intensive Care Unit Design: Current Standards and Future Trends Book Chapter

Informatics for the Modern Intensive Care Unit

December 5, 2017 / Dochitect / Design for Critical Care, Evidence-Based Design

Peer-reviewed publication

Publication: Critical Care Nursing Quarterly
Publication Reference: 2018 Jan/Mar;41(1):60-67
Authors: Diana C. Anderson, Ashley A. Jackson, Neil A. Halpern

Abstract

Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and “smart” intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.

Peer-Reviewed Publications

Decentralization: The Corridor Is the Problem, Not the Alcove.

December 5, 2017 / Dochitect / Design for Critical Care, Evidence-Based Design

Peer-reviewed publication

Publication: Critical Care Nursing Quarterly
Publication Reference: 2018 Jan/Mar;41(1):3-9
Authors: D. Kirk Hamilton, Sandy M. Swoboda, Jin-Ting Lee, Diana C. Anderson

Abstract

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.

Peer-Reviewed Publications

ICU Design in 2050: Looking into the Crystal Ball!

March 17, 2017 / Dochitect / Design for Critical Care

Peer-reviewed publication

Publication: Intensive Care Medicine Journal
Publication Reference: Published online March 17, 2017
Author: Neil A. Halpern, Diana C. Anderson, Jozef Kesecioglu
View article

Some questions, but no answers yet: will illnesses, diagnostics and therapies be very different in 2050 than today? Will acute or chronic organ failure, immune or genetic problems, or sepsis be addressed with supportive care or bioartificial organ replacements, primary organ regeneration or other interventions at the genetic, cellular or immunologic levels? What will technology, connectivity and informatics advances look like? The answers to these questions will all ultimately impact intensive care unit (ICU) design going forward.

Click here to read more about Dochitect’s vision for the future of ICU design.

Peer-Reviewed Publications

Contemporary ICU Design

November 11, 2016 / Dochitect / Design for Critical Care

Book Chapter

Book Title: Principles of Adult Surgical Critical Care
Book Editors: Niels D. Martin, Lewis J. Kaplan
Publisher: Springer, 2016
Chapter Title: Contemporary ICU Design
Chapter Authors:
Diana C. Anderson, Neil A. Halpern

9783319333397Except: The design of an intensive care unit (ICU) is a complex process and requires a multidisciplinary group of professionals. In 2010, there were approximately 6,100 ICUs with over 104,000 beds in the 3,100 acute care hospitals in the United States. ICU design itself is continuously evolving as new guidelines and regulatory standards are developed, clinical models are changing, and medical technologies are advancing. It is highly probable that hospital-based intensivist leaders will be asked at some point in their careers to participate in efforts to design new ICUs or renovate existing ones. This chapter provides an overview to a wide array of design issues and is divided into three sections: an overview of ICU design, confi guring the ICU space, and future trends in ICU design.

Link to Purchase Book and/or Contemporary ICU Design Chapter:

Contemporary ICU Design Book Chapter

Design and Role of the Intensive Care Unit

July 28, 2016 / Dochitect / Design for Critical Care

Book Chapter

Book Title: Handbook of Intensive Care Organization and Management
Book Editor: Andrew Webb
Publisher: Imperial College Press
Publication Date: July 28, 2016
Chapter Title: Design and Role of the Intensive Care Unit
Chapter Authors:
  Neil A. Halpern and Diana C. Anderson

Key Points

  • ICU-specific design is a complex process and requires a multidisciplinary team which includes both clinical and expert design-based professionals.
  • The layout of an ICU is arguably the most important design feature affecting all aspects of critical care services.
  • The core of the ICU experience is the patient room, conceptually subdivided into patient, caregiver and family/visitor zones.
  • Central clinical support zones within the ICU act to bind the patient rooms and other supportive areas together, with the overall goal of supporting bedside care.
  • Deploying advanced informatics into the modern ICU electronically integrates the patient with all aspects of care.

 

Link to Purchase Book:

Handbook of Intensive Care Organization and Management Book Chapter

Intensive Care Unit Design – 25 Years of Winning Trends

June 27, 2016 / Dochitect / Design for Critical Care

Presentations

Presentation Title: Intensive Care Unit Design – 25 years of winning trends
Event: European Healthcare Design Congress
Presentation Date: June 27, 2016
Event Location: Royal College of Physicians, London, UK

Session Description:
The goal of intensive care is to provide the highest-quality treatment in order to achieve the best outcome for critically ill patients. Research supporting the impact of the built environment has exerted a strong influence on multidisciplinary design teams as they seek solutions to maximize operational efficiency and create supportive healing environments for patients, families, and clinical staff.

The ICU is an ever-changing and rapidly advancing environment, with the integration of advanced informatics adding a new layer of complexity to design planning and operations. Future ICU designs will require planning for long-term flexibility by incorporating design decisions that accommodate changing care practices and information technology.

ehd-critical-care-image

Dochitect speaks at European Healthcare Design 2016 about critical care design and provides an overview of winning design trends over the last 25 years. Click here to view a video of the presentation.

Dochitect also judges the European Healthcare Design Awards for Healthcare Design Projects over 25,000M2. Click here to learn more about the awards ceremony and winning designs.

Conference Presentations

What Will the ICU of the Future Look Like

December 11, 2014 / Dochitect / Design for Critical Care

Popular Press

Publication: Society of Critical Care Medicine, Critical Connections Newsletter
Date: December/January 2014, Volume 12, Number 6
Authors: Sandy Swoboda, RN, MS, FCCM; Diana C. Anderson, MD, March; D. Kirk Hamilton, FAIA, FACHA, EDAC; Charles D. Cadenhead, FAIA, FACHA, FCCM; Neil A. Halpern, MD, FCCM; Dan R. Thompson, MD, MA, FCCM
View Article

Demand for intensive care unit (ICU) beds is increasing as the nature of medical practice shifts to become more multi-professional and multidisciplinary. These trends likely will be reflected in both our critical care space design and working practices. Clinicians are spending more time at computers to complete docu­mentation and more time discussing cases with the multi-professional team. Parallel to this shift toward healthcare provider teams is a growing awareness about the impact of evidence-based design principles on patient care and staff efficiency. The environment’s impact on the healing process, infection control practices and safety increasingly are studied in the context of a unit’s design and architectural layout. Hybrid professionals and interdisciplinary groups provide integrated solu­tions that cross disciplines in new ways.

In addition to assembling a task force to update the Guidelines for Critical Care Unit Design, members of the Society of Critical Care Medicine’s (SCCM) ICU Design Committee are champions for change and healthcare improvement. In this article, this diverse group shares their thoughts on the ICU of the future.

Click here to read more from the SCCM ICU Design Committee members about what the ICU of the future will look like.

Additional Press:

Note Dr. Anderson’s viewpoints on this topic, entitled “View from the Dochitect: Reflections of a Physician-Architect on ICU Design,” are presented as part of a panel discussion on the future of ICU design at the Society of Critical Care Medicine’s 43rd Annual Congress in San Francisco, CA; January 13, 2014.

Commentaries, Panel Discussions
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