ICU DESIGN AND CONFIGURATION


a bay, but also having a relationship to the patient. However, reality dictates that the ideal relationship to natural views is not always possible. In the case of the ICU of the Future, daylight simulation and connection to nature scenes were electronically simulated. Future connection to the external environment into the bowels of the building can also consider a more natural fibre optic light conduit technology.


n Sliding door enhancements In this study, the aggregate openings of the pods’ doorways were dictated by the physical limitations of existing fabric. The post-occupancy feedback demonstrated that the sliding doors appeared neither accessible enough, nor to form optimal aggregated openings to be comparable with a set of curtained bays. Enhancements could have been made to both increasing the sliding door opening widths and enhancing their ease of operation. Although good quality manual tracks were used in


the prototype, automatic doors with specially designed activation buttons on the doors themselves could be considered as a more responsive option.


Angelo Pagano


With over a decade’s industry experience, Angelo Pagano has led numerous complex healthcare projects, ‘honing his ability to communicate effectively and deliver superior project outcomes’. His exposure to clinical design has made him methodical in planning, design, and project delivery. Angelo’s extensive


experience in healthcare projects has provided him with deep clinical practice knowledge. Known for his adaptability, he excels in conducting clinical engagement processes, even transitioning to intensive, interactive digital workshops during COVID-19 to facilitate rapid information exchange. He is dedicated to seeing projects through to completion, while his strong communication skills and stakeholder engagement have fostered lasting relationships in both the public and private healthcare sectors.


n Bed bay flexibility To augment the flexibility of each pod further, the amalgamated bed configuration is best if large clusters of beds are used. An isolated bedspace very probably has two solid partitions as its bookends (rigid elements). A pair of bedspaces will have that book-end, one to each room. A large run of rooms minimises rigid walls, and allows opening doors between cubicles. This large run of rooms in planning allows the creation of an efficient hybrid between a private room, and the expansion-capable cubicle (i.e. a hybrid between the two types of spaces: effectively a ‘roomicle’).


Conclusions Various initiatives have been outlined in this article to demonstrate the enhanced clinical environment as per the project’s objectives, centered on improving patient outcomes. These parts of the project were published separately, and demonstrated measurable and replicable attributes which can be applied globally. In addressing new project scenarios where similar


physical constraints apply, the findings evidence successes, but are overall not entirely conclusive in all aspects. The public hospital setting appears more complex for fully integrating the compact solutions compared with the successes seen in equivalent smaller, private sector, scenarios. The latter, private sector examples had the advantage of continuous administration of an overarching vision into daily operations. An overall departmental refurbishment would need to be further pioneered, not just a two-room prototype within an existing department. To succeed, a developed adaptation would need to be built on pre-prioritised project objectives as the integrated driving force of all design decisions, equipment procurement, operational systems, ongoing training, and future opportunity planning.


References 1 Cadenhead C, Anderson D. Critical Care Units: Trends in winning designs”. World Heal Des J 2009; 2(3): 72-77.


2 She SJ, Xu YY. (2023). Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with post-intensive care unit syndrome. World J Psychiatry 2023: Sep 19;13(9):707-713.


3 Desai SV, Law TJ, Needham DM. (2011). Long-term 60 Health Estate Journal May 2025


complications of critical care. Crit Care Med 2011 Feb; 39(2):371-9.


4 Harvey MA, Davidson J.E Post-intensive care syndrome: Right care, right now… and later. Crit Care Med 2016 (44): 381- 385.


5 Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels, S. (2021). Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counselling and treatment strategies. Expert Rev Neurother 2021; 10: 1159-1177.


6 Tronstad O, Flaws D, Patterson S, et al. (2023). Evaluation of the sensory environment in a large tertiary ICU. Crit Care 2023 Nov 27; 27(1):461.


7 Tronstad O, Flaws D, Lye I, Fraser JF, Patterson S. (2021). The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the ‘ideal’ bedspace. Australian Critical Care January 2021; 34(1): 15-22


8 Australian Health Infrastructure Alliance (AHUIA). (2024). Australasian Health Facility Guidelines 2024.


9 Hollander H. Bed room mock ups. A practice research paper for the Queensland Children’s Hospital 2007. Conrad Gargett Lyons, Brisbane.


Additional footnotes A Growth of floor area is a recognised significant capital cost, with associated plant growth, additional walking distances, and addition of associated circulation area.


B They include: using design and technological solutions to optimise the ICU bedspace requirement, and reducing environmental stressors (e.g. noise, light) to reduce the incidence of delirium, improve sleep, improve patient/family experience, and ultimately improve patient outcomes.


C The two ICU of the Future bed pods operate as part of an existing 27-bed ICU.


D Led by the Critical Care Research Group, and supported by a selected team of sponsors, architects, designers, equipment suppliers, builders, consumers (patients and their families), clinicians, and researchers.


E The aggregate area of the two beds was 42.5 m2 (minus


an inefficient bite out of the corner of one of the bays for an adjacent space’s basin alcove and a column). Current Australian Standards for new build call for 50 m2 separate rooms.8


for two


F Not included in the prototype at this stage. G For example: https://patents.justia.com/patent/ 20170039822


H For example, columns which ‘bite’ into a part of a room. I Greater focus on this swinging out of the way was given than would normally be executed in an ICU design.


J Publications: Doing time in an Australian ICU; the experience and environment from the perspective of patients and family members (2021); The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the ‘ideal’ bedspace (2021); Evaluation of the sensory environment in a large tertiary ICU; Evaluation of the sensory environment in a large tertiary ICU (2023); Creating the ICU of the future: patient-centred design to optimise recovery; The effect of an improved ICU physical environment on outcomes and post-ICU recovery – a protocol (2024).


K For instance, is the cause due to no fully integrated mock-up being executed? Is it related to staff replacement and new expectations? Is it because the observations are contrary to normative design standards? Is it due to mixed operational modes being practised within the unit? Or is it simply that the bedspaces are ‘different’, and some staff are finding change from historical behaviours challenging?


L Current standards allow hose reels at an elevated height, providing that the hose discharge is set at an accessible level.


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