ICU DESIGN AND CONFIGURATION
bays, very much deep-planned in the depth of the current active ICU department. With the constricted floor areaE of an already tight floor space of the two curtained bays, the site was very much grounded into a compact solution, out of reach from utopian approaches. This part of the unit was furthest away from the other bays. The other bays had relationships to external window views; the prototype bays did not. Further, although the pair of bays was relatively close to the central staff base, they offered poor visual connectivity, or ‘sight-lines’, which are considered important by ICU clinicians. The bays had a ‘last-resort’ current usage other than being used as a storage or simulation space. In short, the site was windowless, already tight for today’s standards, in the middle of an active ICU unit, and poorly visually connected to the central staff activity.
An opportunity for clever design Such constraints should not, however, be viewed as a hindrance to future design initiatives. They should rather be viewed as an opportunity to consider clever design, making up for, or at least testing the limitations of, the spatial and other shortfalls. This approach informs many similar global scenarios, where the predicament was of having established constraints, previously executed to older standards and expectations. It was thought that if this design could tackle the constraints, this could assist other hospitals facing developing similar scenarios. More specific design approaches included:
n Acoustic transmittance: Whether or not to not enclose the existing bed bays was briefly considered, but there was no known way of controlling stray light or sufficient blocking of externally created sound without physical barriers. The sound masking technology which was already incorporated in the design was beneficial in dampening consistent, unwanted background noise, but the technology was not ready for full cancellation of each unwanted sound wave (particularly the many short and loud noises created in the ICU – e.g. alarms). A wall and well-sealed sliding door, on the other hand, had a sound-mitigating performance. Similarly, light pollution was difficult to control without a physical barrier in the form of a wall. The design response, therefore, formed a controlled enclosure in a way that it remained accessible, selectively transparent, and versatile. A tri-arrangement of sliding glazed doors was designed to allow open-bay configurations and assist nursing staff in managing two patients simultaneously, particularly with an easy, push-open action during the more crowded emergency activities. Door openings allowed a simple bed turn for accessing and egressing the bays. To ensure equity for visitors in wheelchairs, the door arrangement was designed around a set-out for fully graspable, compliant access handles on wide leading door stiles.
n Light pollution: Because the initial research had identified that light pollution was detrimental to the nestled patient inside the cubicle, care was taken to use hospital-standard bed screen curtains as lighting barriers. Standard hospital curtains were draped from around 300 mm above the floor to a height of around 2100 mm. The glazed sliding doors were further designed to light-block the openings under and over the curtains. A double provision of curtains inside and outside the glazed cubicles was also madeF
to allow
the formation of a future light-lock so that night-time clinicians could come and go into the cubicle without stark changes to lighting levels.
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n Reduced equipment noise: As mentioned previously, the selection of equipment searched and encouraged development of reduced alerts and alarm sounds at the patient head (‘quiet’ or ‘silent’ alarm solutions),G
aiming
for solutions delivering alarms directly to the caregiver. This strategy built on prior research.
n Other acoustic ambience: Other than minimising equipment noise and acoustic transmittance from adjacent spaces, a further aspect of design was the treatment of internally created sounds within each bedspace. The ICU environment, with its hard surfaces, has traditionally been thought to be most in alignment with good infection control practices. However, such environments’ prolonged acoustic decay times can result in unwanted ‘lingering’ and build-up of sound, contributing to occupant discomfort, while also creating an environment prone to mis-hearing verbal communications. Because the baseline research identified the criticality of quality acoustic dampening, the design team working with the Infection Control Department found a solution that met both the critical project requirement of reducing the reverberation time and improving sound absorption, balanced against key infection control criteria. This outcome ensured that the wall and ceiling surfaces were selected with preference given to acoustic criteria. A behavioural adjustment, therefore, was required in the operation of the ICU to maintain best Infection Control Practices (e.g. low hand- contact to walls).
n Compact design: The deficit of total available floor area was managed through compaction design techniques and a reduction in selective equipment clutter. The key spatial demands associated with each bed pod were immediate clearance around each bed – i.e. sufficient space to maintain clearance for people and equipment in a non-cluttered way, and being sufficiently flexible to facilitate instant responses such as resuscitation.
The consequence of enclosing the bed bays was that the resulting cellular spaces offer less efficiency – because shared manoeuvring space, as experienced between two adjacent curtained bays, cannot be realised. To make up the deficit, the following design techniques allowed greater functionality than would normally be possible
4920 RECEPTION EDGE EXISTING WINDOWS TO BE REMOVED AND INFILLED. PAINT EXTERNAL FACE TO MATCH EXISTING. 351 PBI STORAGE
POWER AND DATA SUPPLY TO BE INSTALLED ON BED. BED CONNECTION TO SUPPLY THESE OUTLETS
100mm WIDE FIXED DOUBLE GLAZING WITH EACH LAYER FLUSH WITH FRAME ON EACH SIDE. 2100mm H
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CLEARANCE ZONE AROUND BED TO AusHFG (SHOWN GREY)
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Room Number Area / Finish
Door Number Room Number
Roller Shutter/Grille Number Room Number
Operable Wall Number Room Number
Window No. / Room No. Window Type
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Plan of the bed bay pair showing clear zones and remaining areas available for storage and other uses.
PENDANTS SET OUT FROM EDGE OF CLEARANCE ZONE
CURTAIN AT 2100mm H ON BULKHEAD
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PAIR OF MONITORS MOUNT TO GLASS. THIS RELIES ON POWER AND DATA TRANSFERRING THROUGH FRAME OF GLAZING
1 4000 Revision REV DESCRIPTION A Issued for Information DATE INT. 01/03/21 AP
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PLASTERBOARD FIRE-RESISTANT PLASTERBOARD, IMPACT RESISTANT
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100mm WIDE SLIDING DOUBLE GLAZED PANEL WITH EACH LAYER FLUSH WITH FRAME ON EACH SIDE. 2100mm H. WITH WIDE LEADING MULLIONS TO ALLOW AN OFFSET RECESSED PULL ACCESSIBLE FROM BOTH SIDES. AN ADDITIONAL PROTRUDING D HANDLE ON THE TRAILING STILE ON THE TWO LEAFS ACCESSED FROM THE CORRIDOR.
Client Common Good
Project ICU OF THE FUTURE
Drawing GA Floor Plan PBI STORAGE PBF PBI
Issue A1 Scale
Project Drawn 3455 4381 C 4920 L Number 1 : 20
20 416 A
SD - DR - AR - 2100 Author
Copyright Conrad Gargett. ACN 636 465 373 ABN 81 636 465 373 Details
Do not scale this drawing and verify all dimensions and levels on site. Nominated Architect : Lawrence Toaldo NSW Reg. 10255.
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May 2025 Health Estate Journal 57
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PRELIMINARY
Conrad Gargett
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