Intensive Care Units (ICUs) are complex environments to design that are expensive to operate, and are critical for the patients housed there. A growing body of research indicates improved design can help bring about dramatic increases in safety and quality-and particularly reductions in infection, falls, errors, transfers, nurse turnover and stress and increases in satisfaction (Marberry, 2006; Ulrich et al, 2006; Zimring et al, 2006). We have been involved in several projects to bring the evidence to bear on the design of the critical ICU environment.
Evidence-Based Design
Developing an Innovative Neurointensive Critical Care Unit for Emory University Hospital
PI: Craig Zimring
Status: Completed in 2008
Introduction: This project supports redesign of Emory Neurointensive Critical Care Unit. It applied many evidence-based design features, thus in order to create a family and patient-centered healthcare environment.
Issue: Emory University Hospital created its Neurointensive Critical Care Unit in 1998 to care for stroke patients and others with severe brain injuries. The team provided extraordinary care, but the physical facilities were antiquated. The unit took over three 1980s intensive care units (ICUs). The patient rooms were so small that there was barely room for family members to stand next to the bed, much less for a care team to provide high-level care at the bedside.
Approach: The medical director, Emory neuro-intensivist Owen Samuels, M.D.,approached Georgia Tech’s Craig Zimring, Mahbub Rashid (now a professor at the University of Kansas), and PhD students Kem Jayanetra, Keith Jundanian, Bo Seo, and Young-Seon Choi to research comparable units, study how the Emory unit worked, and apply the relevant research linking design to patient, staff, and organizational outcomes. This became an exercise in collaboration and evidence-based design. The Georgia Tech team worked with Samuels and his team and the architects HKS to create a design that would be patient and family centered, encourage effective teamwork, and reduce stress for patients, families, and staff.
Outcome: The unit opened on January 31, 2007, and is innovative in many ways. Patient rooms are large with generous family areas where, for the first time in Emory’s history, families can spend the night in an ICU room. The unit is much quieter, with better acoustics and fewer alarms and is infused with natural light. Families have a large living room, a kids?room, quiet areas, and a backstage space for food, showers, and lockers. The unit has a high-resolution CT machine to reduce transfers for very ill patients. Nurses and other staff have workstations that are designed to support their tasks without distractions. Georgia Tech and Emory continue to work together to document the impact of the new design on patient safety and healthcare quality.
MCG Critical Care 3 West Evaluation:Innovations in Intensive Care Unit Design at the Medical College of Georgia
Sponsor: MCG Health Inc.
PI: Craig Zimring
Status: 2006-2006
Introduction: This report is the product of a joint research project between the Medical College of Georgia, MCG Health, Inc., and the College of Architecture, Georgia Institute of Technology. The purpose of this project was to evaluate the $995,000 renovation of the 20-bed 3-West Wing at the Medical College of Georgia Medical Center, which opened in 2003. Through direct observation, focus-group interviews, comparisons with other facilities (benchmarking), and examination of the research literature, investigators were asked to provide evidence-based conclusions about the effectiveness of the new unit design. The research focused on two general questions: (1) how well does the design of the new unit allow families to establish regular patterns of life and support critically-ill patients, and (2) how well does the design allow nursing staff to communicate and work together while increasing time spent at the bedside? The investigators found that the general decisions made in the design process have resulted in a unit that with which family members and staff are well pleased. However, the investigation revealed a number of possible small changes, which, if implemented, may further increase patient and staff satisfaction.