The Patient Process as the Basis for the Design of an ICU

Abstract

What role does design play in the adult critical care environment? In the early 1990s, the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACN), and the American Institute of Architects/Committee on Architecture for Healthcare (AIA/CAH) co-sponsored an Intensive Care Unit (ICU) design competition to focus awareness on the role of the critical care unit environment in promoting healing of the critically ill. The Swedish Medical Center of Englewood, Colorado, was honored with the fi rst ICU Design Citation among 66 participants in 1992. Lessons learned in the process of conducting the competition were published by the SCCM in 1996, in a book titled Critical Care Unit Design and Furnishing [1]. Around the same time, the major American and European intensive care societies published statements concerning minimal requirements and optimal design [2–3]. Neither the SCCM nor the European Society of Intensive Care Medicine (ESICM) has published updated guidelines in the past decade. What has happened in the fi eld of intensive care design in the meantime? What should we consider when designing the ICUs where we will treat our patients in the decades to come? There is not exactly an abundance of recent technical literature on the topic of ICU design. Koay and Fock published “Planning and design of a surgical intensive care unit in a new regional hospital” in 1998 [4], and Hamilton published “Design for fl exibility in critical care” in 1999 [5]. There were articles presenting the nursing perspective [6, 7] and investigating the effect of design on infection control [8–10]. More recently, the AIA published “Guidelines for Design and Construction of Hospital and Healthcare Facilities” [11]. A revised version of those guidelines is due out in 2006. But the limited guidelines that exist for hospital construction and design are unlikely to address the changes that are sure to take place in healthcare delivery in years to come. While ICUs will certainly continue to exist over the next decades, the general hospital context around them will change substantially. The importance of outpatient care will increase, and inpatient sectors will change from units with regular beds to step-down units, also referred to as intermediate care facilities. Progress in hospital construction will allow a more fl exible ICU area. Flexibility will be an important principle, not only with regard to construction but even more so with respect to the mode of operation. Two The Patient Process as the Basis for the Design of an ICU