Post on 06-Apr-2015
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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?• What do you look for in your ICU design?
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ICU Design
• Evolution of Critical CareEvolution 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• 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 permonth with
No. of days per month
month withmore than 1unoccupied bed
No of days per
No. of transfers per month (Safety parameter)
Minimisation of both the mean and the SD
Nguyen, J. M. et. Al. Intensive Care Med (2003) 29:849–852
y pwith more than 2unoccupied beds(efficiency parameter)
No. of days per month with a full unit (accessibility parameter)
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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/ 100,000 Population
Adult ICU Beds as % of All Acute Care
Hospital Bedsp
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
Wunsh, Hannah et. Al. Crit Care Med 2008 Vol. 36, No. 10
Germany 24.6 4.1
Netherlands 8.4 2.8
Spain 8.2 2.5
Saudi Arabia 3.5 - 5.5
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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
ORRehab Medicine
ICU
Engineering
Laboratory
Ward ER
Engineering IT
RadiologyDischarge
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.
• Easy to maneuver patient and equipment.y p 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 for patient’s chair.p p
• 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
• Designed to avoid splashing
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 AreaADVANTAGES
• Increased visibility• Easier access to patients• Teamwork increased
DISADVANTAGES
N i
• Management easier• Stimulation for patients• Sense of security and support
for inexperienced staff
• Noisy• Busy environment• Scary environment • Decreased concentration• Sensory overload for patients
and staff.
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Single RoomsADVANTAGES
• patient satisfaction• Reduction of infection• Quieter, peaceful, private
DISADVANTAGES
• visibility and access to patients.
Q , p , p• Less sensory overload• Improved quality of sleep• Less anxiety
p• 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
NoiseStrategies for Noise REDUCTION
• Single room
• Double-glazed window sDouble glazed window s
• Silent methods of communication
(Telephone with light signal
instead of audible ring tone.)
• Clear glass screen
• Acoustically absorbent ceilings.
Reference : King Khalid University Hospital
Acoustically absorbent ceilings.
• Wearing soft sole shoes for staff
and visitors.
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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 Requirements for
WINDOWS:WINDOWS:
Double-glazed
With “Blackout”
Easy to clean
Non-openable
Insulation against noise
P t l Prevents glare
Provides visual link to the
outside but does not
compromise patients privacy.
Good positioning to avoid high
glare at midday.Reference : NHS Estates, HBN 57
Lighting
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Ceiling
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.
Source : St. David’s Health Resource Center
FlooringFloor finishing
• Smooth
• Crack free
• Stable
• Easy to clean
• Slip resistant
• Withstand harsh treatment
• rolling of heavy mobile equipments
• regular hard cleaning.
Reference : King Khalid University Hospital
• 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.
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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 FriendsFamily Counseling
Room
• Must have a
d l di t door leading to
the MAIN
Corridor.
• Room décor
should convey
l d
Reference : Austin Clinic
calm and
comfort.
• Telephone
should be
provided.
Support for Families and FriendsSitting 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• Beverage making facilities and Television should be 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.