PIEDMONT HOSPITAL ICUs A visit to Red (Open Heart CCU), Green (NICU), and Blue Units (Med Surg.) with a comparison to a Regular Hospital Room Host: Patricia Black Group Members: Wanlin Xiang, Siming Mao, Ann Rogers, Kushal Waghmare

ICU Blue Configured for maximum storage of supplies both within patient room and outside Sleeping discouraged (no family area) Quiet Ample ambulatory space for nurses

ICU Green Cited by Ms. Black as more problematic than rectangular layout due to difficulty in aligning rectilinear furniture Observed by team members: Less space for nurse alcoves More restricted ambulatory space Disorienting

ICU Red Open Heart (CCU) Same layout as ICU Blue 10 rooms instead of 12

Regular Patient Room No Visibility Inboard toilet in the room Large window >> More natural light Difficult to renovate: Wiring embedded in concrete walls make rewiring difficult Expensive glass doors

Problems at Piedmont noted by Ms. Black Monitoring: Too many machines to nurse: “I’d rather be talking to them or washing their hair, etc.” – Charting: Too much time spent charting Charting often done long after observations are made Charting done on hands – Nurses don’t want to spend as much time in the room as Ms. Black wants them to. Family inclusion versus intrusion Technologies don’t “talk” to one another Building is land-locked, so expansion is difficult Noise of TVs

Problems our group will focus on: “Design for better visibility” 1.“Retrofit Visibility” -- It is difficult and expensive to renovate existing designs – For ICUs (circle layout) – Non-ICUs being renovated to become ICUs

2. “Family Inclusion v. Intrusion” -- The hospital desires to include families in the care process but they interrupt nurse workflow and make them uncomfortable to be observed (causing pain to the patient, e.g.) Problems our group will focus on: “Design for better visibility”

3. “Face Time” -- Nurses don’t get to spend as much time in direct contact with the patient as is desired 1.Because of charting difficulties 2.Because of the profusion of machines Problems our group will focus on: “Design for better visibility”

Ideas for solutions: Problem 1: “Retrofit Visibility” Reduction in the number of rooms ICU Green (Piedmont): Originally had 10 rooms, which were reduced to 8 Using Cameras, Mirrors Outboard toilets and less storage in the room More glass windows Normalizing the round layout…

…Normalizing the round layout Bathroom Family Storage *Depends on available space

Ideas for Solutions: Problem 2: “Family Inclusion v. Intrusion” Headphones Lighted nametag color-coded to indicate availability

Ideas for solutions: Problem 3: “Face Time” Exterior wall-mounted display with touch- screen representation of patient body, for entering charting information Shoulder-mounted audio recording device with speech recognition software Automated Charting done by equipment

Children's Healthcare of Atlanta at Scottish Rite Neonatal Intensive Care Unit

Special layout under limited space visual isolation different color zones visual isolation different color zones physical isolation clapboard physical isolation clapboard

Layout in single unit-group Patient Bed Working Table Family Sofa Swivel Chair Visual isolation Colored patient zone Physical isolation Visual isolation Storage

Visibility when nurses are working at working tables Problem Identified

Field Observation

Proposed Solution Change of layout in unit to allow for better visibility Storage For things not used all the time Before After

Other Problems and Current Solutions Visual isolation is a kind of virtual isolation. Noise: noise suppression Infection: negative air pressure Family visiting: leave enough distance … Could there be better solutions?

Thank you