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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?

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ICU Design

• Evolution 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

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Modern ICU

Team meeting

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Things to discuss
• No. of beds in 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 per

No. of transfers per month with
month (Safety more than 1
parameter) unoccupied bed

Minimisation of both
the mean and the SD

No. of days per

No No. of days
y pper month
month with a with more than 2
full unit unoccupied beds
(accessibility (efficiency parameter)
parameter)

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

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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/ Adult ICU Beds as %

100,000 Population of All Acute Care
p
Hospital Beds
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
Germany 24.6 4.1
Netherlands 8.4 2.8
Spain 8.2 2.5
Saudi Arabia 3.5 - 5.5

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

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Correlation between intensive care unit beds per 100,000

population and healthcare spending per capita in eight countries.

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

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

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

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ICU Location
Rehab OR
Medicine
Laboratory

Ward ICU ER
Engineering
IT

Discharge
Radiology

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

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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

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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.
• Easyy to maneuver p
patient and equipment.
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
p for p
patient’s chair.
• Sufficient space for 2 visitors.

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Pendants

Reference : King Khalid University Hospital

Pendants

Reference : King Khalid University Hospital

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Handwash Basin
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 Area

ADVANTAGES
• Increased visibility
• Easier access to patients
• Teamwork increased
• Management easier
• Stimulation for patients
• Sense of security and support
for inexperienced staff

DISADVANTAGES

• N i
Noisy
• Busy environment
• Scary environment
• Decreased concentration
• Sensory overload for patients
and staff.

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Single Rooms
ADVANTAGES

• patient satisfaction
• Reduction of infection
• Quieter,, peaceful,
Q p , private
p
• Less sensory overload
• Improved quality of sleep
• Less anxiety

DISADVANTAGES
• visibility and access to
p
patients.
• 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

Noise
Strategies for Noise REDUCTION

• Single room
• Double
Double-glazed
glazed window s
• Silent methods of communication
(Telephone with light signal
instead of audible ring tone.)
• Clear glass screen
• Acoustically absorbent ceilings.
• Wearing soft sole shoes for staff
and visitors.

Reference : King Khalid University Hospital

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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).

Reference : King Khalid University Hospital

Lighting (Natural Lighting through WINDOWS)

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

Reference : www.jpshealthnet.org

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Lighting (Natural Lighting through WINDOWS)

Requirements for
WINDOWS:
 Double-glazed
 With “Blackout”
 Easy to clean
 Non-openable
 Insulation against noise
 P
Prevents
t glare
l
 Provides visual link to the
outside but does not
compromise patients privacy.
 Good positioning to avoid high
Reference : NHS Estates, HBN 57 glare at midday.

Lighting

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Ceiling

Source : St. David’s Health Resource Center

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.

Flooring
Floor 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.
Reference : King Khalid University Hospital

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ICU Design

Reference : King Khalid University Hospital

Nursing Station

Reference : King Khalid University Hospital

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Offices, Family Counseling Room

Visitors Area,
Seminar Room

Nursing Staff lounge and locker,

Doctor’s On Call Room

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Support for Families and Friends

Family Counseling
Room

• Must have a
d
door lleading
di to
t
the MAIN
Corridor.
• Room décor
should convey
calm
l and
d
comfort.
• Telephone
should be
provided.
Reference : Austin Clinic

Support for Families and Friends

Sitting 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.
provided
• Have its own WC.

Reference : Brackenridge Intensive Care Unit

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Conclusion

Knowledge of critical care needs is essential.

Future ICU Design should be spacious, environmental

friendly, safe, patient centered and technically sound.

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