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INTENSIVE CARE FACILITIES


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. Sound measurements undertaken in the ‘old’ intensive care unit identified levels constantly above 50 dB, peaking at over


Figure 2. The glass windows and doors to patient rooms can be electronically changed from ‘clear’ to opaque to provide privacy.


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: l Fewer hospital-acquired infections. l Fewer medical errors. l Improved patient sleep. l Fewer falls. l Improved patient privacy/confidentiality. l Improved communication.


l Increased patient satisfaction. l Better social support. l 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


Figure 3. All the patient rooms have a standardised design. IFHE DIGEST 2020


Figure 4. ‘Nature-themed’ photographs show local scenes. 45


©Samuel Hoisko


©Samuel Hoisko


©Samuel Hoisko


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