Observation and Analysis of ICU Designs. Blake Fenwick & Hugh Stehlik

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1 Observation and Analysis of ICU Designs 1

2 Abstract 2 Through observation and research, this study aims to identify key areas for improvement in the Intensive Care Unit (ICU). The study focussed on bedspace layout and the interaction between individual pieces of equipment, patients and staff. Firstly we conducted an analysis of the development of ICU design and its key aspects. From here subsequent field work was undertaken at Canberra Hospital and Calvary John James Hospital located in Canberra, Australia, through user-observations and unstructured interviews with users of the ICU bedspace. The results of this study are illustrated by informed practical solutions, both immediate and projected, that improve the efficiency and usability of the ICU and the quality of patient care.

3 Research 3 Literature Review and Case Study analysis of current ICU design and technology. User Observations and Interviews conducted in two ICU s in Canberra, Australia.

4 ICU Bedspace 4 The sicker the patient, the more pieces of equipment we have to use. ICU Specialist, Canberra Hospital ICU The nature of the ICU being high dependency and critical care, results in a lot of equipment being needed. As this quote from an ICU Specialist at CH suggests, there is a need for more and more pieces of equipment as the severity of a patient s condition increases. On one occasion we observed a patient with 13 major pieces of equipment in one bedspace. One major issue that arises is the lack of uniformity and collaboration between equipment. It is hard to organise the current equipment effectively as their shapes are all so different and do not integrate with each other. Also by virtue of their function, most machines are very large. An ICU patient surrounded by equipment Nurse station and ventilator withing an ICU bedspace

5 ICU Bedspace 5 An observed scenario showing numerous pieces of equipment and staff interacting to treat a patient. Canberra Hospital ICU, ACT, Australia.

6 Cords & Tubes 6 Cords & Tubes running between the patient and equipment A key aspect of this research study is the abundance of cords and tubes in the ICU bedspace. First and foremost, the issue of restricted access to the patient. This is due to the cords and tubes running between the patient (in bed) to the outlets on the headwall (approx. 1m behind patient head. Numerous staff members in different positions discussed the importance of having clear access to the patient s head at short notice. Cords and tubes in the bedside area also present a serious trip hazard for staff members, particularly nurses who spend the majority of their time in this space. Further issues associated with the cords and tubes include tangling and delineation. Getting in under is difficult, I put the lines up but some people put them down. Sometimes you fall over them, trip on them or need to stoop down. Nurse, Canberra Hospital ICU

7 Equipment 7 Once you ve got a person in a chair... there s often nowhere to put the bed other than in the bedspace. Nurse, Canberra Hospital ICU Two of the largest pieces of equipment used within the ICU bedspace are the bed itself and patient chair. The patient chair is not always in use, however when the patient is in the chair the bed must remain in the bedside area. This is incase of an emergency when the patient must be moved back to the bed for CPR to be performed. Typical equipment within the ICU bedspace environment To facilitate storage and manoeuvrability, smaller devices are attached to larger mobile elements. An example of this is medication infusion pumps being attached to poles with wheels. In this case there can be three or four devices to one pole that not only makes them top-heavy but also limits the handling points for nurses.

8 The Future of the ICU 8 The first step in developing the futuristic design for the ICU bedspace was analysing the existing configuration. We quickly realised that a certain amount of equipment, cords and tubes would always need to be present in the space. One solution is reorganising the equipment within the bedspace to allow for more efficient patient access. Fig. 1 These 3D renderings represent the potential evolution of ICU bedspace organisation over the next five years. Fig.1 illustrates a basic current ICU bedspace (based on Canberra Hospital). Fig.2 implements a solution for power organisation in the form of a retrofitted power board attached to the side of the bed. This limits the amount of cords running between the bed and headwall. Fig.3 expands on this concept by incorporating IV pumps and bags into the bed and the use of a bed power docking system. Fig. 2 Fig. 3

9 The Future of the ICU 9 The final outcome of this project is a futuristic concept for the ICU bedspace. Highly conceptual in nature, it is imagined as a design for The concept is a hub in the centre of the bedspace, integrating multiple systems and pieces if equipment into one design into which the bed docs and becomes a part of. As a response to the futuristic aspect of the brief the concept utilises several advanced, emerging technologies as well as some simpler and more practical solutions. The bed docks into the main hub via a wireless connector plate positioned in the floor. This allows the bed to be powered and to share information with the main hub without the need for a precise connection point. When not connected the bed is powered by a battery housed in the base. The design features a large, subtly curved column that houses utility outlets for gas liquid and power. This column blends into a rectangular rail that sits directly above the bed and supports three separate semi-transparent OLED screens. The screens can be raised and lowered independently of one another and are housed by the rectangular rail when raised. The OLED screens provide a large amount of space for medical staff to view detailed patient information. They are semi-transparent to allow staff to monitor the patient even when the screens are lowered and displaying information.

10 The Future of the ICU 10 Evolving the ICU bedspace

11 Acknowledgements 11 Project Initiator: Dr. Balaji Bikshandi, Director Intensive Care Unit Calvary John James Hospital. Project co-supervisors from the University of Canberra: Associate Professor Carlos Montana-Hoyos and Assistant Professor Stephen Trathen. The research group would also like to specifically acknowledge: Louise Whitby - who was instrumental in contacting Dr. Biksahndi with the University of Canberra Emeritus Prof. Bill Green, ergonomist and initial contact in the Univ. of Canberra. Associate Professor Frank Van Haren, senior staff specialist of the Intensive Care Unit of Canberra Hospital. Dr. Imogen Mitchell, Director of the TCH ICU, who supported this project and facilitated its conduction in TCH ICU. Helen Rodgers research co-ordinator for TCH ICU. Elisha Fulton associate of Helen Rodgers in TCH ICU.