Balancing Patient, Family Needs for Privacy With ICU Needs
from Caring For Our Future, Spring 2006
By Lynn F. Cavaliero, RN, MS, Clinical Director, Newborn Center, Transport and Neonatal Programs
and Karen Jones, RNC, BSN, Clinical Coordinator, Newborn Center
Figure 1: Overhead view of a
four-patient pinwheel.
Late in 2001, we began the design process for the Newborn Intensive Care Unit (NICU) at The new Children’s Hospital. A major consideration in our design decisions was the room configuration. The overall hospital design team made a philosophical commitment to go from semi-private rooms to private rooms in the medical, surgical, research and oncology units.
The Pediatric Intensive Care Unit (PICU) had already gone to all-private rooms, and the Cardiac Intensive Care Unit (CICU) was moving toward mostly private rooms and some open bay beds. The number of beds for the new NICU was slated to be 60. Presently, the existing Newborn Center consists of 23 physical NICU beds and 27 physical beds in the Infant Care Center that are designated as step-down or intermediate care from the NICU and the CICU. When we move to our new hospital, all our beds will be combined into one location in the NICU, still serving the same population of patients, i.e. intensive critical-care neonates and intermediate-care neonates from the CICU (age still to be determined, but could be as old as 12 months).
Due to space configurations, the hospital design team decided that the NICU could not be all-private rooms, so our process began with team assessment, parent input, site visits, architect brainstorming sessions and review of the developmental literature.
Figure 2: Overhead view of
a three-patient pinwheel.
The Standards for Newborn ICU Design (2002) helped provide clear guidelines for space allocation as we looked for options other than our present open-bay configuration. We all agreed that our present design did not adequately meet our family-centered care objectives for the new NICU. We wanted more private space to support our families, who are often here for extended periods of time (sometimes up to five months) and from as far away as Montana, Wyoming and Nebraska . We also have new moms who have delivered their infants in other facilities. When those infants were transported to us, these moms leave the delivery hospitals as soon as they are medically able. We wanted to be able to provide them with more postpartum amenities and comforts that creative space design would afford us. One design option that we had seen was the pinwheel configuration first utilized in two Ohio hospitals, Good Samaritan Hospital and Dayton Children’s Hospital. We visited Good Samaritan to see how they had incorporated the pinwheel design into NICU care and consulted with the Dayton NICU director. We were anxious to see how noise and light guidelines were being implemented and how family and staff spaces were addressed. A member of our nursing staff, the planning team, two members of our leadership team and one of the architects assigned to our project visited, all bearing cameras and lists of unanswered questions.
The information we gathered and our observations supported the decision that combining a configuration of 50 percent private rooms and 50 percent pinwheels would meet our needs with some adaptation to the layout of the pinwheels. The pinwheels we saw (and described in the literature reviewed) were in a four-patient configuration (Figure 1) allowing for 94 square feet to 120 square feet total space encompassing the cabinetry, headwall, patient bed (incubator, warmer, crib), ventilator, IV pumps, parents’ chair/rocker and staff charting area. Due to the complexity of our patient population, the amount of equipment at the bedside, and our commitment to meet the Standards for Newborn ICU Design’s recommendations of 120 square feet as the minimum space within our pinwheel design, we decided to go with a three-patient pinwheel design (Figure 2).
How Do These Design Decisions Impact Patient Care and Staffing?
Front view of a single unit in a
pinwheel at our new hospital.
Our philosophy will be to reduce the number of moves a patient and family will experience during their admission, ideally staying in one location from admission to discharge. We also have a practice model of primary patient care in which the nursing team commits to a patient from admission to discharge. We have established a task force to sort out how our nurses, neonatal nurse practitioners, pediatric nurse practitioner and physicians will integrate the care of intensive and intermediate patients into a care flow that accommodates these philosophies.
There are several challenges facing our nursing staff with our new unit. One will be the change in space: the unit covers 26,000 square feet, nearly triple our present space. The staff will no longer be assigned in close proximity to one another; they will have to rely on technology to link their patients together. Staff have always been able to see across the units and easily ask for help. The new design eliminates this type of visibility and access to other nurses, creating another challenge. It will now require two clinical coordinators on a 24/7 basis to maintain the needed support to staff and families for the unit. We are thinking about the potential for an 11 a.m. to 7 p.m. resource nurse. As we continue to work through these challenges, staff will need to make many adaptations to this new work environment. The overriding benefits to our patients and families keep the excitement high and anticipation focused toward the fall of 2007, when the pinwheels and private rooms will be the new home for the NICU.
References
Standards for Newborn ICU Design, 6th Edition. [On-line]. Available: http://www.nd.edu/~kkolberg/DesignStandards.htm .
