The Universal ICU
In the winter of 2002, Desert Samaritan Medical Center in Mesa, Arizona, opened what it bills as the first surgical “universal ICU” in the United States. While similar units have been operated for cardiac patients in other areas of the country, the Desert Samaritan facility is available to postsurgical patients requiring care of decreasing intensity, without their having to transfer from unit to unit. HEALTHCARE DESIGN recent-ly asked the architect and the nurse manager in charge of the project to describe the new unit and its implications.
“This concept got its start when Cathy Merritt, Desert Samaritan's nursing supervisor, saw a mock-up of a similarly designed medical ICU by the Hill-Rom Company. She liked what she saw in terms of reduced patient transfers and tracking, and continuity of nursing care. When we were brought into this, as designers, we saw that mock-up and, after discussing it with Desert Samaritan staff, thought we could make a surgical ICU perform the same function, i.e., look as though things are changing for the patient as he or she gets better, with equipment appearing and disappearing as needed.
“The commercially available headwall was not quite what we wanted, so we custom-designed a new one, going through three or four mock-ups—a costly process, but we wanted to get this right. The resulting headwall looks like a piece of furniture with an attractive curved top, but it contains vital treatment and monitoring equipment. When the patient needs such equipment—blood pressure and blood gas monitors, telemetry, vacuum systems, etc.—the doors fold open and slide back, remaining out of the nurses’ way at all times. As the patient improves, the doors close by stages until the headwall looks like a piece of furniture again—an excellent cue to the family that the patient is getting better.
“The room is about twice as big as the standard ICU room—about 400 sq. ft. It has residential wallcoverings and lamps, as well as a colorful two-toned floor. The colors and finishes in the room make it look like one's own bedroom.
“By dividing the ICU into zones—for patients, family, and staff—we made things easily accessible for everyone. Staff can do its job conveniently, and families can relax and spend time in the room without being tucked away in a waiting area someplace.
“We have also designed the unit so that the nurse-charting stations are located next to the rooms, one to every two rooms. The nurses are closer to their patients, and nurses of different specialties all work on the same patient in the same room and can easily communicate with each other without having to do much walking. The ICU nurses are, by and large, excited about this approach and, if this takes off, it's what everyone's going to do.”
“All the medical gases, critical outlets, tubes, wires, etc., are hidden in the headwall. Ventilators, balloon pumps, dialysis equipment, and so on are wheeled in and out, as needed. All the critical equipment is essentially hidden behind the patient, but it is readily visible for family and staff to monitor. As the critical patient advances to the telemetry stage, equipment is rolled out of the room, monitors are pushed back, and the headwall begins to close. The family can see that notable progress is happening.
“Within the room we have the patient zone—with the bed system, monitoring, and dialysis equipment—and the caregiver zone, with ready access to charting, supplies, and hand washing. Also, the caregiver zone is set up ergonomically, with utility outlets at waist height, clean and dirty linen readily accessible from the hallway and room, and standing-height charting/work space. There is also a hygiene zone, which is essentially a private bathroom, and a family zone, set around the corner from the bathroom in an alcove within the room, with a small desk, a personal computer with Internet connection, a closet, and a chair that converts into a bed. This provides a respite area for the family, a ‘corner of sanity,’ with the added reassurance of proximity to the patient.
“For the nurses, this will be a growing experience. Nurses have typically been segregated in their specialties: intensive care, telemetry, and med/surg. Now there is more overlap, and there are more teaching opportunities and better continuity and consistency of care. Nurses can readily obtain information from each other about the patient, get consults, and more accurately track changes in the patient's condition. And the patient, from his or her standpoint, is seeing the same nurses every day.
“The decentralization of work areas is another paradigm shift. Medical people are social creatures, but there is an advantage to moving from the traditional nursing station, where everyone congregates, to a decentralized system. Our new unit offers both. We have four nursing substations set apart at equal distances along the crescent-shaped unit; they're somewhat set back from the hallway, so people can chat and discuss cases with some degree of privacy. We also have the decentralized charting stations located outside each patient room, which keeps the nurses in closer touch with the patients, with a minimum of traveling about. We're finding that the nurses are adjusting to this quite easily. As we developed and operationalized the unit, we involved the staff who were going to work there in the entire planning process. As the time of their actu-ally taking care of patients within this new paradigm grew closer and closer, we found that the staff became very excited.” HD
Desert Samaritan Medical Center