The Institute for Patient-Centered Design’s 2013 design competition set out to advance neonatal intensive care unit (NICU) environments, and results of the effort are still going strong.

It started with a challenge to the design community to develop a solution that would enable parents to remain in the NICU with their babies 24 hours a day. Key design concerns included the selection and placement of a comfortable chair in which parents could provide kangaroo care, provisions for a bathroom for the postpartum mother, and a designated space for parents—both inside and outside of the patient room.

The competition was an essential element of the project because it enabled the institute’s development team to collect ideas from the industry at large. It also provided an unexpected advantage of identifying the need for education on the current best practices in NICU care so designers could better understand their role in facilitating those practices. For example, many design submissions positioned the parent's chair across the room from the incubator. This demonstrated a need to explain the parent's role as an active participant in the infant's care rather than a passive, powerless onlooker. Using this information, the team was able to simulate activities, such as kangaroo care, to help designers understand the physical implications of their decisions on the care that parents and providers deliver in the NICU.

The competition’s three winning submissions inspired the creation of a simulation lab that showcased their best features. Those projects were Hospital for Sick Children in Toronto by Stantec, MedStar Franklin Square Medical Center in Baltimore by Hord Coplan Macht, and Bon Secours St. Francis Health System in Greenville, S.C., by McMillan Pazdan Smith Architecture.

The build up
The simulation lab was showcased at the 2013 Healthcare Design Expo & Conference in Orlando, where attendees provided feedback that inspired a next iteration of the model. For example, the value of solid surface countertops to reduce the likelihood of germs (especially in wet areas) was confirmed, but the team opted to revisit the casework. An under-counter waste receptacle was removed to eliminate the noise associated with its hardware and to answer infection prevention concerns. The team maintained a full-height splash guard at the sink but created a larger under-counter space to accommodate and fully vent the refrigerator, which opens like a drawer to prevent the escape of cold air, is virtually silent, and is mounted at a height that prevents the bending and reaching of postpartum mothers storing their breast milk or staff who are cleaning.

The team also set out to incorporate real windows into the model to study the implications of visual and thermal comfort within the space. While it maintained cordless, cleanable blackout shades inside the patient room for the purpose of enabling a completely dark environment when necessary, the team installed electrochromic glass in the common space where natural light is welcomed. This glass can be programmed to tint automatically during daily cycles when the sun is at its peak to protect against unwanted heat but also shield occupants from uncomfortable glare, allowing them to enjoy unobstructed exterior views. The team’s goal to explore a cleaner, smarter alternative to blinds resulted in a more energy-efficient solution, as well.

Back to school
Perhaps the most fun had during the project’s course was when the institute took the NICU lab to students who used their ingenuity to innovate the environment. The institute mentored design courses at Georgia Institute of Technology (Georgia Tech) and Stanford University to educate students on NICU needs and challenge them to develop solutions for areas that the project’s development team considered unsolved.

The Georgia Tech industrial design master’s studio, taught by professor Wendell Wilson, involved site visits to NICU spaces, interviews with nurses, and interaction with NICU parents. Students identified problems to address, with the top two solutions submitted by Gen Li and Teng Shao. After observing tangled cords and tubing that sometimes touched the floor, becoming dirty and presenting a tripping hazard, Li created an IV tube management system to allow caregivers and parents to determine the path of the tubing through a series of clips holding the tubing in place. These clips were designed to prevent accidental tugging on the baby’s IV site during kangaroo care by placing a control point on the parent’s arm. Meanwhile, Shao noticed the frequency of parents’ cell phone use in the NICU and determined that a wearable device would offer a convenient option to increase the likelihood of sanitizing after touching cell phones or other “germ carriers.” The solution can be worn like a watch, and each time its sensor comes in contact with a sensor mounted on the incubator, it reminds parents to sanitize before touching their babies.

A diverse group of Stanford University students tackled the NICU challenge in a 48-hour design charrette, part of a course taught by industrial designer Jules Sherman and neonatologist Dr. William Rhine. The winning team included mechanical engineering students Josh Feler and Mikkel Soerensen and business student Graeme Fielder. Their project was developed from the need to have a waste receptacle in multiple areas of the room while avoiding the noise and disruption created when housekeeping empties the trash. Parents on the project’s NICU advisory committee complained about the noise made when bags were shaken open in the room, stating cases when they could see their infants flinch, startled by the noise. NICU nurse participants also pointed out the need for a large receptacle that could be located at the bedside for procedures but discretely located elsewhere when not in use. To solve these issues, the team designed the “spinbinz,” a large waste receptacle on casters that could move around the room as needed and would dock in a panel that could be accessed from the corridor, allowing housekeeping personnel to replace the bag from outside the room.

Last stop
The Institute for Patient-Centered Design presented all of these solutions at the 2014 Healthcare Design Expo & Conference in San Diego during its Patient Experience Simulation Lab sessions. As a living laboratory, the institute continues to receive input from the users of NICU spaces to continue to provide solutions to challenges faced in this space.

This year, the institute partnered with Zanardo Architects PC to implement changes to the lab for its final installation. Improvements include an updated color scheme, which allows the NICU families more control to personalize the space. The team also added new furniture that’s designed to be easily cleaned, comfortable, and user friendly. Finally, sound-reducing drywall was used to promote a quiet environment. The simulation lab will be built at Nexxspan Healthcare in Atlanta, opening in summer 2015.

The institute will continue to engage the healthcare design community with opportunities to collaborate on learning laboratories to improve patient and family accommodations. More information about the NICU project is availab
le at www.ifpcd.org/nicu. The institute’s annual design challenges can be found at www.ifpcd.org/competition.

Tammy Smith Thompson, NCARB, EDAC, is the president of the Institute for Patient-Centered Design. She can be reached at tthompson@patientcentereddesign.org.