As part of a larger plan to increase bed capacity within an existing wing of the hospital, Dartmouth-Hitchcock and Lavallee Brensinger Architects (Manchester, N.H.) collaborated on the creation of a new 13,500-square-foot critical care unit at Dartmouth-Hitchcock Medical Center.

From the outset, the project goal was to create a flexible, efficient treatment environment, which would also support the center’s commitment to family inclusion in patient care. The unit houses 14 additional critical care beds, as well as a new reception and greeting area.

Using Lean design practices, the unit was programmed to ensure staff and supplies are arranged in optimal locations. For example, support spaces are located near the top of the unit, along a cross corridor, making them central to both sides. The angle of the corridor itself was developed to best accommodate stretcher and supply movement across the unit.

The conference room serves as the unit core with nurse stations and two medical supply rooms surrounding this space. The centralized location minimizes nurse travel time from work stations to patient rooms, which are located directly across the corridor.

Building Information Modeling (BIM) guided the design process and views throughout the unit were studied within the model to confirm that none of the observation stations or patient rooms would be isolated.

Each new patient room is acuity-adaptable and is split into three zones:

  • The staff zone is located immediately inside the door and contains a work surface with a sink. There’s also space for a mobile medical supply cart. A wall-mounted computer between the staff zone and patient bed is housed on an articulating arm. Images on the computer can be transferred to a television at the footwall.
  • The patient zone contains two prefabricated headwall units, space for bedside equipment, dialysis connections at the head, and an overhead patient lift. The boom was chosen to provide flexibility for bed layout within the rooms, allowing them to take on different functions in the future.
  • The family zone located along the window features a daybed, recessed locker storage for family and patient belongings, a television, and individual temperature controls. Storage under the daybed holds pillows and blankets. A cubicle curtain is stored in a small niche behind the boom and provides privacy between the patient and family zones.

Charlie Welch, director of operational services at Dartmouth-Hitchcock Medical Center, says response to the layout has been overwhelmingly positive. “The increased and decentralized equipment storage and medical supply space has helped eliminate clutter in the corridors,” he says. “Nursing staff also appreciate the monitoring alcoves close to their patients.”

Since the critical care unit opened in May, Dartmouth-Hitchcock and Lavallee Brensinger have been monitoring the performance of its Lean programming features and new technologies. The team will present data and analyses at the 2014 Healthcare Design Conference in San Diego, in November. For more information, visit