ICU Tours Temi Yembra, Sarah Manning, Stephanie Allen, Sukanya Bhattacharya, Surabhi Satam, and Kruti Shah

Piedmont Hospital There were 5 ICUs ICU Green Built in 1970 Medical surgical ICU Very small rooms with odd angles Round shaped ICU with central nurse station Advantages: Visibility into all rooms Disadvantage: Not enough movement space for equipment and furniture.

Piedmont Hospital ICU Blue Medical, surgical ICU - built 5 years ago 12 bed ICU Moderate room size No provision for family accommodation Room monitors are connected with the Central mother monitor ICU Red Open heart ICU

Piedmont Hospital 5 East ICU Newly built about 2,3 years ago 10 beds ICU - small rooms Stepdown Unit Converted general patient rooms in ICU Total 9 beds and rooms are very small Nurse station is far Disadvantage - visualization problem

General Information Visitation is open except during hand-off Nurses 12 hour shifts 1:1 or 1:2 depending on patient condition Physicians in ICU Intensivists - Who specializes in the care of critically ill patients, mostly in ICU. Extenders – Expert physicians or nurses that replace experienced doctors in the ICU in the midnight to early morning shift.

Problem - Clinical Documentation Changed to electronic 7 years ago Physician and progress notes still on paper Electronic medical records do not all talk to each other

Solution - Clinical Documentation Develop a software to integrate medical records - Within the hospital - Ability to access records from other hospitals - Helps know what medication the patient is taking

Problem - Patient Falls Prevalent within men in their 50s - 60s Side effects from getting up after receiving narcotics

Solution - Patient Falls Created a falls protection program Provide susceptible patients with green armbands to be recognized If possible, place such patients in rooms with cameras Follow checklists and protocol

Other problems Size of ICUs - Too many cabinets in rooms - Converted from regular patient rooms Most walls are concrete made which is a problem in - Taking any new telephone line through walls - Making changes in the present room size

Scottish Rite Average Staffing Ratio is 2 patients to 1 nurse Age Ranges of populations Served Neonate, 30 days Infant, 30 days to 1 year Early Childhood, 1 year to 5 years Late Childhood, 5 years to 13 years Adolescent, 13 years to 17 years Adult, 17+ years

Scottish Rite Neonatal ICU (NICU) o 35 beds (3 isolation rooms) o Pinwheel Design o Sterile and non-sterile areas o Typical healing time : 28 days o Three types of alarms system - Orange: To call the nurse - White : Parents need help - Blue : Patient in crisis

Scottish Rite Pediatric ICU (PICU) o 26 beds in 3 L-shaped Pods o Private Rooms (helps reduce infection rate) o Overhead Boom o 3 separate entrances- 2 for staffs 1 for visitor o Typical healing time: 4 days

Problem - Privacy in NICU Open layout (see and hear activity in other patient areas) No Visitors During Shift Changes (7am and 7pm May discourage parents from staying at the bedside

Research Opportunities Best practices in communication Alternative communication o Mobile alerts o Pagers o Online access to full/limited medical records NICU Layouts o Bowling Ally o Pinwheel o Private Rooms

Problem - Family Space in ICU Overarching Issue: ALL patients must have a parent/guardian present to consent NICU Parents/Visitors typically sit in "hallway" area There is very limited privacy for parents Area not suited for overnight visits o Alternatives  NICU Family Waiting Area  7 Private Rooms Hospital-wide  Ronald McDonald House

Problem - Family Space in ICU PICU One sleeper chair per room No designated family area in room If in Pod 2 or 3 the travel to the family waiting area is far

Research Opportunity Effectiveness of layout in Rehab at Scottish Rite Ample floor space Designated Family Area Allows for less strict visitation policy Effectiveness of family oriented-layout at other hospitals

Research Opportunity Waiting Area Design and Amenities o Seating Area o Sleeping Area o Eating Area o Secure Storage o Entertainment Area Paging/Locating System

Problem - POUS in PICU Nurses and Respiratory Therapists frequently leave room to retrieve supplies RN comment: Visit OMNI Cell 20+ times per day OMNI cell is very far away for some pods RN loses visual when retrieving supplies

Research Opportunity Space in PICU ICU rooms allows more supply storage Are carts being used effectively? Are drawers and cabinets being used effectively? What is the optimal par level of supplies in room? What kinds of supplies are charged to the patient and charged to the department?