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INTENSIVE CARE FACILITIES


Figure 3: All the patient rooms have a standardised design.


valuable information collected for use during the construction project (e.g. on room location, routes, accessories, and furniture). In all nearly 250 individuals commented on and gave feedback on the ‘VR’ design models.


Pre-occupancy evaluation The pre-occupancy evaluation used to obtain information on the existing premises and its functions revealed that, in staff’s view, the 1977-built facilities were both old-fashioned and crowded, with shortcomings in lighting, acoustics, and ventilation, insufficient space around the patient, especially given all the new technology incorporated, and little privacy. Safety was, in fact, the only element to get a good score – thanks to the unit’s compact design, good visibility, and effective safety and security policies. The unit’s staff also took part in workshops focusing on the forthcoming changes to their working patterns. In the first they carefully considered the ICU’s functions, identified key working practices to take forward into the new unit, and reflected upon the anticipated changes to collaborative nursing practice, while in the second they created ‘new prototypes for action’, for use when nurses need support and help from colleagues. In the third workshop they finalised and cleared common policies and guidelines. During the construction phase job rotation was introduced to help orientate the team and familiarise staff with the functions of unified wards.


Physical studies of individual temperature The project also saw physical studies undertaken and questionnaires completed to evaluate individual team members’ thermal comfort within the new facilities – with measurements of individual skin temperature. The calculations to achieve the optimal temperatures were undertaken using the Human Thermal Model (HTM). An indoor temperature of 23˚C, adjustable by ±3˚C to ensure individual thermal comfort, was recommended.


Excess noise was identified as a source of stress for both patients and staff, with a negative impact on sleep and recovery.


30 Health Estate Journal February 2019


Figure 4: ‘Nature-themed’ photographs show local scenes.


Sound measurements undertaken in the ‘old’ intensive care unit identified levels constantly above 50 dB, peaking at over 90 dB. Improving the acoustics was thus a clear objective for the new ICU. The introduction of new technology demands staff readiness to exploit it. The use of a ‘Sensors-as-a-service’ questionnaire identified the types of services and technologies staff would be keen to use. At the top of the list were door opening, tap operation, computer opening, and the operation of glass privacy walls which turn ‘opaque’ at the touch of a button. The most popular technologies, meanwhile, were smartphones, ID cards, or ‘tokens’ for access control, and a wristband or other smart ‘accessory’. A trawl through existing evidence-based design research identified multiple advantages for single patient rooms – many of which would address the shortcomings of the rooms in the existing facility. The benefits of single patient rooms, identified in research (Ulrich et al, 2008), are: n Fewer hospital-acquired infections. n Fewer medical errors. n Improved patient sleep. n Fewer falls. n Improved patient privacy/confidentiality. n Improved communication. n Increased patient satisfaction. n Better social support. n Fewer patient transfers.


Expertise and knowledge sought So, did we obtain the expertise and tacit knowledge of the staff? The methods we used provided them with the chance to demonstrate their expertise and tacit knowledge, and indeed there were a number of issues that the designers could not fully appreciate without some understanding of the activities undertaken


in an ICU. The project provided an opportunity for the staff to improve the process of care, and to use ‘Lean’ thinking. The methodologies used saw significant useful information obtained to inform the architectural design process.


Construction of the new ICU Research findings from previous EBD studies and the EVICURES project’s goals placed demanding requirements on the design of the new unit, posing a number of challenges – one being the hospital management team’s wish to bring together all the intensive and intermediate care facilities within the unit. Research results indicated that, for a hospital of this size, unifying the facilities made logical and practical sense, because the staff’s wide-ranging expertise can be harnessed more efficiently, and both the quality of care and outcomes improved. The hospital’s intensive care unit, neurological intermediate care unit, coronary care unit, and gastro-surgical observation unit, were thus brought together to form one ‘united’ intensive and intermediate care unit. The interventional cardiac unit – equipped with six observation beds – was also accommodated within the plans. The second challenge was to determine whether all the rooms should be single rooms, because the original space allocated was insufficient to allow this. Plans for a 100 per cent single room facility and for a set number of rooms were, however, maintained. The new ICU incorporates 24 single patient rooms for intensive and intermediate care. The 2,400 m2


facility,


on two floors, was formed via the refurbishment of an old ward with two extensions. The new ICU is on the same floor, with offices, meeting rooms, and a staff cafeteria one floor below.


Opaque glass


To ensure good visibility, the walls between the patient rooms and the doors are glass. To maintain patient privacy the electric glass windows can be changed from clear to opaque ‘in seconds’ (Fig. 2), while the nurse stations provide good visibility to patient rooms.


Figure 5: The display terminals of the smart control centre.


All the rooms feature a standardised design, while mobile cabinets accommodate


©Samuel Hoisko


©Samuel Hoisko


©Samuel Hoisko


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