ICU DESIGN AND CONFIGURATION
Images from an early project study ‘without physical constraints’.
These issues were not new, and were already
extensively recognised through the design consultation period. Increasing the size of the bedspaces was out of scope for this project. There were therefore no surprises in the challenges encountered. What was unexpected in the feedback was that adaptations of operational practice were not as settled as anticipated. In addition, the aggregate sliding door openings, which allowed spatial limits to flex and extend outside the bay boundaries, were not recognised in the description of adaptive operational techniques.
Curtained bed bays Upon analysis, the mix of having virtually all other curtained bed bays within the unit appeared to have caused a bias in comparison. The curtained bed bays allowed an instant ‘ballooning’ of one function overspilling into the next adjacent space. The expansion with the new enclosed bays was more an adjusted behaviour in using the doors. Because the curtained bay was simple and familiar behaviour, there was a temptation to not use the prototype bay for the very sick patients. Since patient comfort and wellbeing are better served by the enclosed bay, the boundary adjustment of the flexible edges ought to be a more readily accessible solution in the future. Further observation showed that the department’s
broader stock of equipment could not be modified for the context of the prototype (e.g. the existing mobile X-ray). Therefore, not all observation could demonstrate a complementary setting. In addition, wider ancillary functions, such as storage systems outside the bed bay, were not included in the scope of the prototype project – meaning that only partial conclusions can be noted in this regard. Other, more particular comments critiqued reachability of fitments, clocks, bins, and the like. Regardless of detailed consultation having been executed over a six-month period during the design phase, there were sufficient comments during the post-occupancy stage to investigate the causes of the observations more closely.K However, since the results of these latter detailed findings do not affect the principle of applying compacted designs in future settings (i.e. those details can be adjusted within a further designs), they are not discussed in detail here.
In applying and learning from this research into future comparable ICU upgrades, the following recommendations are made:
n Compact versions of handwash bays and fire hose reels Many existing examples of ‘bites’ out of the corners of rooms are evident in global settings. These include, adjacent fire hose reels, handwash bays, storage alcoves, and/or columns (with particularly significant sizings in high rise or high-seismic zones). As is partly evident in this study, these ‘bites’ – which subtract amenity from rooms – can be disruptive to planning clearances, hinder room access, stifle room flexibility, and limit uniform handing, universality, or modularity.
Basin alcoves are often set out on principles of market availability. A little more careful design development reveals that a significantly more compact version can be developed without compromising the splash zone, cross-corridor traffic collisions, elbow clearances, visual encumbrance, or infection risk. This summons a call for a worthwhile design review for similar circumstances where rooms are compromised because of a ‘bite’ out of their corners.
Similarly, fire hose reels which ‘bite’ into the functional space of an adjacent room can be rationalised. In Australia, at least, they can be eliminated using performance solutions, or at least by placing the reels up at a height,L
out of the functional area of a room.
n Enhanced links to family and carers In this study, considerations tied into extending existing hospital systems, including nurse call and food ordering. The development of technology that aids accessible and effective patient-to-carer communication is moving rapidly. Consideration should be given to the installation of an effective equipment package in a future design because it is likely to affect the basis of the layout. The twin goals of maximising integration, and giving patients and their families the option to play their own media, should not be forgotten.
n Fibre optic lighting A window which has a visual link to a pleasant outdoor setting is preferable, i.e. not just having a window to
Harm Hollander
Dr Harm Hollander is a practising Australian architect, who says he ‘works to make his next project the best design to date; in academia to exceed present standards by inspiring reflective professional analysis and a collaborative future, and in research to try to stand on the shoulders of giants’. He is immersed in his research expertise to build and retrofit a flexible hospital building fabric, without the burden of additional, initial capital costs. He has served as an architect driving design and procurement teams on major hospital projects around Australia, as well as on some international projects.
May 2025 Health Estate Journal 59
Sachin Behere, Low Cheaw Hwei, and Nigel Geh
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