Chest
Volume 145, Issue 2, February 2014, Pages 399-403
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Postgraduate Education Corner: Contemporary Reviews in Critical Care Medicine
Innovative Designs for the Smart ICU

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Designing a smart ICU is a time-consuming, complex, multiphased, political, and costly exercise. This process begins with two notions: First, all hospital parties agree that a new or renovated ICU is required, and second, the hospital has agreed to allocate space, personnel, and fiscal resources for the project. In this first of a three-part series on innovative designs for the smart ICU, we will explore the roles of the ICU design team in managing the design process. The team must be administratively empowered, knowledgeable, and forward thinking. The first charge of the design team is to develop a clear vision for the goals, look and feel, and functionality of the new ICU. This vision must be guided by the imperative to positively impact patients, staff, and visitors. The team must concentrate on innovative but practical ideas that are in compliance with building codes and design guidelines and address issues related to renovation vs new construction. Mock-ups, both physical and computer generated, and a simulation laboratory for advanced technologies should be used to test design assumptions and reveal problems well in advance of actual ICU construction and technology implementation. Technology platforms need to be standardized within the ICU and equipment purchases protected against early obsolescence. The ramifications and expectations of the new ICU must be thoughtfully considered and dealt with during the design process. Last, it is essential that the design group continue its involvement in the new ICU during construction, occupancy, and post occupancy.

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Working With the Organization and Building the ICU Design Team

ICU design can succeed in creating top-of-the-line ICUs only if the critical care medicine (CCM) team and the hospital administration share similar design aspirations and clinical goals. Four core principles should be considered from the outset. First, an ICU is a semiautonomous mini-hospital. Second, designing an ICU is a complex and time-consuming process. Third, the successful design balances innovation with functionality, space availability, physical limitations, and cost. Last, the design

Design Timeline

From the start of design to occupancy may take 3 to 5 years. Efficiency requires that the design team be rapidly exposed to excellent ICU design concepts. This may be accomplished through review of video presentations and descriptions of ICU design award winners9 (Award Winning ICU Designs at SCCM.org) and visits to select ICUs. Frequent team meetings are necessary, and the process will benefit from regularly scheduled reviews of updated schematics and computerized renderings of the design

The Vision

The vision of the new ICU precedes the details of the design and should reflect the “hoped for” look, touch, and feel of the new ICU. The vision also addresses the big-picture issues of patient care, workflow, technology, environment, and the ICU relationships with the remainder of the hospital.8 Several questions are optimally considered early in the process so the vision and design are reality based. Is the ICU project a renovation or new construction? How will the ICU be physically related

Renovation or New Construction

ICU renovations come in several formats. An existing ICU may undergo a cosmetic upgrade or a total overhaul, or a new ICU may be built in another hospital location. Renovations are commonly more restrictive in scope and more complicated to design than new ICU construction because of the inherent limitations of the current structure (ie, floor to ceiling heights, structural depths, elevators, and staircases) and requirements to update the site to current building codes. A renovated ICU will

Technology Standardization and Purchase

Optimally, the technologies (ie, mechanical ventilators, infusion pumps) being considered for the new ICU should be standardized both within the new unit and with other ICUs across the enterprise. Standardization allows staff to move easily from room to room and ICU to ICU and minimizes staff training requirements. Additionally, standardization simplifies equipment maintenance contracts and permits quantity discounts on capital purchases and consumables.

Current medical devices (ie, infusion

Advanced Technologies

Clinical experience with evolving technologies, even if they are US Food and Drug Administration approved, may be minimal. Therefore, the design team, in conjunction with hospital informatics and biomedical engineering personnel, should test the new technologies in a simulation environment prior to purchase and deployment. Testing needs to broadly address the individual technologies and their networking, connectivity, and interoperability capabilities with ICU and hospital middleware and the

Ramifications and Expectations of the New ICU

The consequences of the new design on staffing, workflow, logistics, infection control, and informatics must be continuously assessed. For example, if ICU beds are being increased above current levels, then more staffing and potentially new types of staff and management models may be required. Similarly, if point-of-care testing is being newly incorporated, the ICU staff needs to be trained and credentialed and the workflow coordinated with the central laboratory before the new ICU opens.

Team Roles During Construction

Periodic ICU design team tours of the ICU site during construction are beneficial. Unanticipated problems may be recognized early and design corrections suggested. However, change orders and constant adjustments to the project may extend the project timeline and budget and result in “scope creep.” Photograph all phases of the construction; these pictures will provide a format for knowledgeable repair or retrofitting. Their use in slide presentations will also help keep ICU staff engaged in the

Occupancy, Postoccupancy, and Do-overs

Delegate a team to transition all aspects of the old ICU to the new one. Temporary relocations or plans for a phased ICU occupancy may be necessary. Moving-in day problems are minimized if all aspects of the new ICU are tested to verify that they are functioning to specification14 and the move itself is simulated prior to the actual changeover. Patients and their families may not share the excitement of the ICU staff during the transition from a known to an unknown environment.

Formalize a

Conclusions

Designing and building a new ICU is a complex, multiphase process that requires careful management by a dedicated ICU design team composed of the key ICU, hospital, and consulting stakeholders. The ICU design should positively impact patients, staff, and visitors. The ramifications and expectations of the new ICU need to be thoughtfully considered throughout the design process.

In the second installment of this series, I will address each element of the ICU ranging from the design of the patient

Acknowledgments

Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Halpern is a consultant to Cardiopulmonary Corp; Pronia Medical Systems, LLC; and Instrumentation Laboratory. He is a member of the ICU Design Award Com mittee of the Society of Critical Care Medicine and The Intelligent Hospital Advisory Board of the RFID in Healthcare Consortium and is a principal of Critical Care Designs. The Memorial Sloan-Kettering Cancer Center ICU was the

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Funding/Support: This work was funded by the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

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