ICU DESIGN AND CONFIGURATION


A demonstration of tri- sliding door openings.


n Sharing of space As already noted, the division of cubicled dual bedspaces into two separate, cellular spaces has spatial penalties. To allow the continued use of shared space, the tri-sliding door arrangement allowed for occasions where an opening between bays is advantageous – e.g. in the case of sharing of nursing support between two adjacent patients, or where the quantum of equipment is at extreme peak demands.


within a more contemporary comparable floor area allocation:


n Accommodation for large items of equipment The floor area clearance around the bed largely kept to the clear area recommended by current Australasian Health Facility Guidelines.8


This clearance allowed the


Oystein Tronstad


Oystein Tronstad graduated as a physiotherapist from the University of Queensland in 2002. He is an experienced ICU clinician and researcher, and has published over 40 peer- reviewed manuscripts to date. Physiotherapy clinical lead at The Prince Charles Hospital, Brisbane, Australia, he is responsible for the cardiology, critical care, and surgical programmes. He is currently leading the clinical research team of the Critical Care Research Group, and is the Project manager for the ICU of the Future project, investigating how an optimised ICU environment and design can impact patient outcomes. He is currently completing his PhD on this topic, and has presented his research widely at national and international forums.


flexibility for a variety of equipment around the bed, as well as maintaining space for procedures such as emergency resuscitation. An exception to this clearance zone was the lesser room, which contained an existing ‘bite’ out of its foot-end corner due to a column and recessed basin bay of an adjacent room. The intrusion was considered less than ideal, but was left for ‘value’ reasons, as well as to test actual circumstances which are common encumbrancesH


around the world. n Storage of equipment


One potential solution to fairly constricted bed bays was to increase storage capacity and storage accessibility to the whole ICU unit. Such an approach encouraged a procedural adjustment to keep unnecessary equipment out of bays. Whole-of-unit enhanced solutions were out of scope for this project, and therefore were analysed and suggested as separate projects, although none of the initiatives have been activated during the operational review period. A second allowance was to maintain a full-length, clear


universal storage zone within each bed bay. This storage accommodation was already part of the AusHFG but was in this case given the priority over other spatial allocation, such as tertiary desk space. As well as accommodating medical equipment, this bay would allow visitors’ chairs to be accessible and flexibly located as per daily requirements, or changed according to patient acuity routines.


n Control of size and quantum of fitments Maximum flexibility is often realised when loose, mobile fitments are used in lieu of fixed ones. The number of permanent fixtures was therefore minimised. Where they still needed to be fixed (e.g. in the case of services engineering outlets), fitments were reticulated through fully articulated pendant arms for swinging out of the way. Ambience was also considered an essential component


of the design, ensuring that the bedspaces were functioning in a sterile and clinical manner while designed to look more familiar and comfortable for patients. Colours were chosen specifically to reduce pain and anxiety. Pendants were finally selected to be minimally dominating within the bedspaces, i.e. avoiding as much patient and visitor intimidation without compromising clinical efficiency, but also with the ability to periscope out of the way into ceiling voids when not needed.


58 Health Estate Journal May 2025


n Corridor Because the particular corridor’s context was a more likely route for daytime activity, an opportunity was structured to allow the main bedspace workstation on wheels to be nocturnally located just outside the glazing enclosure, within a second set of light barrier curtains, which partly shared space with the corridor width during quiet times.


n Opening up of rooms The sliding door arrangement allowed a large proportion of the room perimeter to be easily accessed to an aggregate open position. Maximising the aggregate opening of the collective two bays allows flexibility – as demonstrated in an external study, which analysed the use of patient accommodation during resuscitations and other times of intense occupation. The study found that if dimensions were tightened in one direction, the actual distribution of persons and associated equipment would satisfactorily flow into other parts of the available space, such as a bleed into the connected corridor (like squeezing a balloon in one zone makes a bulge appear elsewhere).9


Post-occupancy research results for compact layouts The findings based on the project objectives are separately published.J


The aspect of compacted room


sizes was worthy of a further post-occupancy study, and is discussed here. For this topic, an open-ended questionnaire was distributed, with the findings collected from volunteer clinical team members. These questions, distributed more than one year after instigation of operation, asked: 1: Did you need to adapt your practice in any way to provide clinical care within the physical bed space you are currently working in?


2: Are there procedures which remain challenging in the current bed space due to spatial limitations?


3: Did you need to communicate any information specific to the current bed space to other staff to facilitate regular clinical care?


4: Did you need to communicate any information specific to the current bed space to patients or visitors to facilitate their care and wellbeing?


5: Do you find differences in the functionality between these two bed bays that impact your routine?


Almost predictably, the smaller bedspace, with the bite out of its corner of its plan, was identified to be less than ideal for reasonable functionality. The larger bay fared better, but was noted to be limiting in manoeuvring and placing large items of equipment. Some items of equipment, such as existing mobile X-ray machines, were not comfortable to use within the available space. Similarly, large numbers of people in the room, or situations with aggressive/ agitated patients, were felt as spatially constrained. A consequence of the tight room was that there needed to be a substituting of one inward item of equipment for another item to exit it.


Conrad Gargett


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