Mahbub Rashid, Ph.D., RA
Patients are admitted to ICUs unit either because they require high intensity monitoring and life support by specially trained health care providers or because they require high-intensity nursing care that cannot be provided on a general medical or surgical unit. Critical care in ICUs are generally provided by ICU teams composed of critical care doctors (e.g., intensivists or pulmonologists), critical care nurses with specialized training, respiratory therapists, physical therapists, nutritionists, social workers, technicians servicing and maintaining vital equipment, and pastoral care staff providing spiritual and emotional support for patients and family members.
Common reasons for ICU admissions are respiratory compromise, hemodynamic compromise, myocardial ischemia or infarction, neurological compromise, gastrointestinal bleeding, renal and metabolic failures, sepsis involving very serious infection in the blood or tissues, trauma caused by injuries that often require surgery, and postoperative complications. Patients come to ICUs from operating room (OR) or post-anesthesia care unit (PACU), emergent care center (ECC) or emergency room (ER), and medical or surgical wards, and other facilities that do not have the resources to provide the level or type of critical care.
While nearly all ICUs are capable of providing a spectrum of care, many have developed a focused area of excellence including (1) care of critically ill and injured children in the pediatric ICU (PICU); (2) adult cardiac diseases in the coronary care unit (CCU); (3) perioperative care, trauma care, and care of multiple organ dysfunction in the surgical ICU (SICU); (4) care of neurological and neurosurgical patients in the neuroscience IC(NICU); (5) transplant patients in transplant ICU (TICU); (7) burn patients in Burn ICU; and so on. Many teaching hospitals also have graded critical care centers such as intermediate care units and telemetry units where patients who require more than acute care can benefit from specific monitoring and intervention.
The vast array of technology present in an average ICU has become incredibly complex, costing tens of thousands of dollars per patient bed. In ICUs, monitors measure body functions such as breathing and heart rate. These monitors often have alarms that sound to alert the ICU staff when such body functions are outside of a normal range. Intravenous catheters (tubes) are inserted in patients’ veins to dispense medicine, fluids, and nutrition as needed. Mechanical ventilators (also called respirators) are machines that help patients breathe through a tube that is inserted through the mouth or nose into the trachea (windpipe) and is connected to the ventilator. Other common devices are dialysis machines, intra-aortic balloon pumps, trans-venous pacemakers, and intravenous medication pumps. The number of devices being used at any time generally depends on severity of illness, etiology, and research purpose. The use of a vast array of technology in ICUs while saves lives can become a safety issue when not designed and maintained properly.
Below, some of the key design areas within an adult ICU and their key design considerations are discussed. Since research involving ICU design is an emerging field of study, there remains a lack of evidence based design considerations in many key areas of ICU design. Therefore, expert opinions are also presented in relations to these several key areas of ICU design.
Layout. One determinant of ICU layout is direct monitoring of patients by clinical staff. In ICUs, patients need constant visual monitoring, because their conditions may change quickly and unpredictably and these changes need to be recognized early. Some ICU patients may also require frequent neurological assessments and/or bedside procedures that may involve multiple members of a care team working. A physical layout that supports visual monitoring and effective face-to-face interaction and collaboration in the unit is thus required.
Another determinant of the ICU layout is outside window for each patient room. By law ICU patients now must have direct access to natural light. The number and arrangement of patient rooms consequently depends on the amount of perimeter wall available in the unit. Therefore, designers often select compact shapes with high area-perimeter ratios to accommodate the maximum number of patient rooms for any given area. They also put most support areas including nurse work areas in the core that do not require any outside window to reduce the walking distance between clinical support areas and patient rooms.
Reduction of cross-infection, traffic volume, and noise level are also among the other determinant of the ICU layout, and each of these factors becomes more significant in larger hospital units. Studies suggest that patients in larger units have higher rate of infection. Larger units also have more traffic and noise sources. These noises sources commonly include, but not limited to noises of other patients (e.g. snoring, crying), monitoring alarms, telephone rings and conversations, conversations among staff, staff entering or leaving, staff wondering, sudden voices, footsteps, falling objects, noises of respirators, slapping of doors, visitors talking, and so on. Breaking a larger unit into smaller units, pods, or clusters may reduce infection and noise. However, pods can break down the visual and social cohesiveness of a unit, and multiple pods may make movement of supplies difficult because they create more service stops. Thus, the appropriate configuration for a large ICU remains a matter of striking the right balance among various contradictory factors.
Size. According to the Guidelines for Intensive Care Unit Design, 8 to 12 beds per unit are considered best from a functional perspective. A small neuro-ICU with less than 6 beds may be inefficient to operate and manage. In contrast, in a very large unit without proper unit design and/or a sufficiently large nursing staff, patient monitoring and care may become difficult.
In the United States, the Life Safety Code also affects ICU design by limiting the size of any suite to 5000 square feet if it does not have intervening smoke partitions and fire-rated doors. The area per bed of a unit ranges from 650 square feet to 1200 square feet or more depending on function on the unit, so most units require smoke partitions and/or ‘hold open’ smoke doors. Hospitals and designers need to ensure that when any one part of an ICU bigger than 5000 square feet becomes unavailable in the event of fire or smoke breakout, the other parts of the unit have the required components for patient and staff safety.
Location. Important departmental relationships of ICU should be carefully considered during the site selection process. Convenient physical movement across departments may help reduce many safety risks associated with patient transfer. Delays, communication discontinuities, loss of information and changes in computers and systems during patient transfer can contribute to increased medical errors and loss of staff time and productivity. Patients can get hurt and most back injuries of nurses occur during patient transfer. Thus, ICU design must include factors that help reduce the time and effort involved in patient transfer.
Patient Room Design
A patient room is the basic working unit of an ICU, and it affects patient care including safety, privacy, and comfort. A patient room in ICUs should include: 1) well-defined functional zones to eliminate conflicts; 2) enough space that is appropriate for patient care; 3) necessary life support systems; 4) adequate toilet facilities; and 5) provisions to balance visibility and privacy, reduce nosocomial infections and ICU psychosis, and to reduce patient and staff injury.
Patient Room Layout.
The patient room layout defines the size and location of functions and their relationships within the room. It affects how functions are performed and how patients and caregivers interface in the room. There can be 4 different zones within a patient’s room: The patient zone includes the bed, bedside and overbed tables, and the immediate area occupied by clinicians when providing care. The hygiene zone includes the patient toilet, sink, and activities associated with patient’s hygiene. The staff zone includes the area just inside or outside the entry to the patient room to support nursing and caregiver functions; this may include a writing surface, provisions for hand hygiene, patient information, medication, and supplies. Finally, the family zone may include seating and/or provisions for overnight stay, storage space, separate lighting, internet access, and a writing surface, among others.
Defining the patient room in terms of what is in a patient’s view and what is not can be important. Evidence suggests that patients lying on an ICU bed are stressed when they see medical equipment, accessories, and monitors. Therefore, it is reasonable to keep these devices away from the patient’s view, and instead put family space within the patient’s view. Architectural treatment of areas within a patient’s view also can be important since it appears that “positive distractions” (e.g., nature) can reduce stress and pain and that natural light can reduce analgesic use. Soothing color and light, natural materials, and paintings of nature may be used in the area within the patient’s view to make the experience comfortable.
Patient Room Size.
The need for larger patient rooms is increasing in ICUs. Advocates of infection prevention recommend that each patient room should have dedicated patient care equipment to reduce cross-infection. Others also recommend that each patient room should have a dedicated family space, with amenities to improve family integration with patient care. As medical breakthroughs and advancements occur more technology is brought in patient rooms requiring more space. The increasing multidisciplinary nature of patient care in ICUs also requires patient rooms to accommodate larger medical teams. Additional space also may be needed in patient rooms to support research and the increasing number of procedural interventions performed in ICUs.
The 1995 SCCM Guidelines stipulates, “Ward-type ICUs should allow at least 225 square feet of clear floor area per bed. ICUs with individual patient modules should allow at least 250 square feet per room (assuming one patient per room). . .” [2:5]. More recent studies show that the average size has increased to 300 square feet, suggesting that hospitals are aware of trends such as the demand for family spaces in patient rooms.
Privacy and Visibility in Patient Rooms. Even in moments of extreme crisis, privacy may be required to preserve individual dignity. Privacy is an important indicator for individual satisfaction in many environments including hospitals. Studies show that hospitals with more private rooms tend to have higher patient satisfaction. Private patient rooms also provide dedicated space for individualized care without disturbing other patients and can help reduce noise, improve patient sleep quality, and support staff-patient communication. Nosocomial infection rates in ICUs with private rooms also are lower because of improved airflow, better ventilation, and more accessible handwashing facilities. Further, the private room design allows for a patient care environment with more control over optimal environmental conditions. In private rooms, however, patient visibility is often at a stake and patients are afraid of being left alone.
From a clinical viewpoint, it is easier to make a case for open patient rooms than private room in ICUs; this permits easy visual monitoring of the patient by the clinical staff that can affect patient safety. ICU staff members often prefer an open ICU to see everything that happens, to readily seek help from others in a crisis, and to act immediately in groups without the constraints of walls of a private patient room. In private patient rooms, therefore, where glass often is used for patient visibility, measures to ensure visual and acoustic privacy of patients and their families when needed are necessary. Hospitals often prefer breakaway glass doors, since they can be closed for privacy, noise reduction, and infection control and still maintain maximum visibility of patients and monitors. Breakaway glass doors also allow maximum clearance to move patients in and out of the room. In an emergency, breakaway glass doors allow the room to become more open than the other doors. However, with breakaway doors closed it may be difficult to hear ventilator alarms [Figure 2].
Life Support Systems in Patient Rooms. Easy access to the patient’s head and the ability to move the patient bed around during procedures are important in neuro-ICUs. Traditional head wall systems, used since the 1970s, do not allow easy access to the patient’s head, nor do they allow clinicians to reorient the bed when needed. Headwall systems include power outlets and outlets for medical gasses and vacuum on one or both sides of the patient bed. Some installations also include wall-mounted monitors and equipment for patient vitals and in ICUs [Figure 3].
More recently, power columns, whether rotating or static, have been used in many ICUs to provide the life support systems. Equipped with medical utilities, power outlets, and monitors, these power columns allow easy access to the patient head and may allow clinicians to reorient the patient bed. Two, instead of one, power columns—one on each side of the patient bed—can be installed to help increase the symmetry of functions around the patient bed. However, it can be difficult to work around power columns during a procedure [Figure 4].
Other more recent innovations e.g. the ceiling mounted boom [Figure 5], ceiling columns [Figure 6], or the Draeger Ponta Beam help provide easy access and sufficient flexibility for proper patient care in ICUs and in particular provide accesses to the patient’s entire body and especially to their heads. These ceiling-mounted systems, however, add cost and often require additional structural support. These systems may also conflict with a patient lift system in an ICU patient room.
Toilets in Patient Rooms.
ICU patient rooms are not required to have toilets, but there are many good reasons to have a toilet in the room for both the patient and families. Toilets in patient rooms can be used to dump and clean bedpans. The location, use and design of a toilet or of other devices to eliminate waste have a significant impact on ICU design. The current design practice shows that toilets are placed in many different locations in relation to the patient room. Inboard toilets are on the corridor side of the patient rooms; outboard are on the window side. The toilets of two adjacent patient rooms are also put next to each other in a wet zone. Each has advantages and disadvantages [Figures 7 & 8].
Nosocomial Infectionsamong Patients. In patient room design, air quality, single-bed patient rooms, lighting conditions, noise level, and handwashing sink/s are important, because they can help reduce nosocomial infections among patients. Most studies show that: 1) private patient rooms can reduce cross-infection among ICU patients; 2) single-bed patient rooms with high-quality HEPA filters and with negative or positive pressure ventilation are more effective in preventing air-borne pathogens; and 3) multi-bed rooms are more difficult to decontaminate and have more surfaces that act as a reservoir for pathogens. The 2006 American Institute of Architects Guidelines for Design and Construction of Healthcare Facilities therefore has adopted the single bedroom as the standard for all new construction in the United States.
Infrequent handwashing among healthcare staff is another factor that contributes to nosocomial infections. Design factors that may discourage handwashing include poor location, poor visibility, uncomfortable sink height and a lack of redundancy and wide spatial separation of resources that are used sequentially in hand washing. There are conflicting results on the effects of physical design on handwashing compliance. There is, however, a consensus that a multi-strategy intervention that includes staff education, easy visual and physical access to sinks, standard sink locations in all patient rooms, comfortable sink heights and alcohol-based dispensers may help increase handwashing compliance.
The current design practice shows that handwashing sinks are placed at many different locations in the patient room. They include locations right outside the patient room entranceway, immediately after the entranceway either on the footwall or on the head wall, somewhere in the middle of the footwall, and at the far end of the patient room walls. Designers and hospitals must consider the advantages and disadvantages of each of these locations.
Psychosis among ICU Patients. Comatose and/or paralyzed ICU patients who are confined to bed may suffer from delirium, also known as ‘ICU psychosis’. There is growing evidence from non-ICU settings that both natural light and outdoor views can help patients maintain sensory orientation and circadian rhythm. Consequently, the Guidelines recommends, “If windows cannot be provided in each room, an alternate option is to allow a remote view of an outside window or skylight” (SCCM, 1995, 2:5).
Artificial lighting conditions that mimic the variations in natural light also can help patients maintain sensory orientation and circadian rhythm. Looking at a ceiling or a wall painted in solid colors for a long period also may contribute to patient delirium. Warm colors and paintings of nature may improve the environment for patients. Sometimes a calendar that shows the date or a digital-clock that shows date and time may help patients adjust their internal physiological rhythm. However, the monotonous clicking sound of an analog clock can cause distress in ICU patients.‘ICU psychosis’ also may be associated with a high level of noise in ICUs. Noise level in the ICU ranges from 50 to 75 dB, with peaks up to 85 dB. Hospital noise can be improved if proper design and management measures are in place.
Reducing Patient Falls and Their Severity. The physical environment can be a root cause for patient falls. Decentralized observation units next to patient rooms may help reduce patient falls. Patients may suffer more injuries when they fall on vinyl floors compared with carpeted floors. The risk of fracture is less for wooden subfloors than concrete subfloors. Patient lifts and other transfer devices, and innovative acuity adaptable patient rooms also can help reduce patient fall and injury.
Other Patient and Staff Injuries. Manual lifting of ICU patients presents a high risk of injury for patients and nurses, e.g. dislodgement of invasive tubes and lines, shoulder dislocation, fracture of fragile bones, and patients dropped during manual handling. Skin tears and abrasions also may occur when patients are pulled up or across beds and manual patient handling can contribute to pain in critically ill patients. The use of ceiling lifts can help limit risks associated with manual moving. If possible lifts should extend into the toilet room. If patient volumes and staffing patterns allow, ICU rooms that can flex in acuity from super-acute to step-down also may reduce patient transfers and the associated injuries.
Staff Work Areas and Support Spaces ICUs can be stressful workplaces. Staff turnover rate is greater in ICUs because of the stressful working conditions. ICU design, however, can help relieve staff stress by reducing unnecessary physical labor, by providing amenities, and through positive distractions for staff physical and mental recovery.
Staff Work and Support Area Location and Layout. There are three basic nursing unit configurations: centralized nursing station, nursing substation, and nursing observation units [Figures 9 & 10]. In older hospital units, a centralized nursing station is generally the main component of the staff work area. In older units, a centralized nursing station is the place where clinical management, staff interaction, mentoring and socialization occur.
However, centralized nursing stations may contribute to errors and inefficiency because of noise, crowding, and the considerable walking distance from patient rooms. In more recent hospital units, the centralized nursing station often is replaced with several decentralized observation units with direct observation of one or two rooms and located either just outside or inside the patient room. It is believed that the decentralized observation units would increase efficiency, but perhaps at the cost of staff “social life”. Team workstations, sometimes distributed throughout a unit, provide spaces for interdisciplinary teamwork, mentoring, clinical management and social functions that may not be feasible in the totally decentralized observations units.
Hospitals also may use different combinations of the basic nursing unit configurations in ICUs. The relation of the support or service areas to nursing units also differs from unit to unit. A “hybrid” nursing design model may be able to strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care. Therefore, to decide which nursing unit and support space configuration meets the need of a unit, hospitals should consider how various design features of these spaces affect staff stress and effectiveness, staff communication, and task performance.
Staff Effectiveness and Stress. The location of supplies and equipment and of electronic charting impact the time spent in patient care by nurses. Nurses spend a lot of time walking, which includes the time to locate and gather supplies and equipment and to find other staff members. Decentralized nurses’ stations and supplies’ servers next to patient rooms may allow nurses to spend more time in direct patient care activities.
Nurses also spend much time in charting. When charting is not done at or near the bedside nurses may spend more time away from the bedside to prepare and store charts at other locations or make more mistakes in charting because of memory lapses between the time of information collection at the bedside and putting it on the chart.
Noise is associated with emotional exhaustion and burnout among ICU nurses. Excessively high noise levels in healthcare settings can interfere with work, and so can frequent interruptions. ICU patients often have numerous monitoring and recording devices with alarms that may also contribute to staff stress and fatigue. Nurses may become insensitive to alarms, because every alarm may need not immediate attention. The interface between technology and patients can also be a challenge for ICU staff and contribute to stress. It is expected that technology innovations will help overcome some of the interface related problems.
Staff Communication. Staff communication is a major variable in ICU safety. A high degree of involvement and interaction among caregivers can influence patient outcomes. When designing staff areas in ICUs, the following should be considered: 1) Physical design can affect the quality and the quantity of interaction. 2) Location of people and activity, and physical distance among workers may be linked to their informal communication. 3) Proximity of workspaces may predispose to the development of an informal group among compatible people as an outgrowth of the informal communication associated with proximity. 4) Spatial arrangement including the location of functions, walls, partitions, furnishings, and other barriers may affect cohesiveness and interaction among groups. 5) Visibility and accessibility play a powerful role in the way individuals perceive and use workplaces, and communicate within. 6) Time spent in walking by staff may be related to time spent in patient-care activities including nurse-physician interactions.
Spaces for Families
Family members have an important role as surrogate decision-makers in ICUs. They can also help patients perform daily functions, understand concerns about health, foster a link to the environment, reinforce self-esteem, and enhance positive relationships by offering love and comfort. In addition, families can also help busy nurses and physicians.
Location of Family Spaces. The location of family waiting spaces in ICUs has both practical and symbolic importance. Having family members nearby often helps to shift an ICU’s culture and make families a part of the decision making process. However, this may also require clinicians to create structured ways of dealing with stressed family members. Symbolically, the presence of family spaces located outside the unit may suggest that families are not integrated with patient care whereas those provided within the patient room may indicate that families are well integrated with patient care. Depending on their accessibility and comfort, family spaces provided within the unit but not in the patient room can suggest the family role is in a state of flux in the unit. These impressions can, at times, be wrong. Some units may still not allow families to play an active role in patient care even with families present in the patient room. Hospitals should consider providing family spaces at several of these locations for different functions and amenities. When possible, each patient room should include a well-defined family area to allow families to be present for shift change report, teaching sessions, care-planning discussions, and daily medical rounds. A family space within a patient room provides families a more comfortable environment for activities and being able to sleep in the patient room provides social support and reassurance for the patient and family members.
Family Waiting Area Layout. The number of ICU patient rooms, the availability of family space in the patient room, the average length of patient stay, and the types of amenities are some of the issues that help determine the size of a common waiting space. Waiting areas should be divided in sections to provide more intimate and quieter resting spaces and relatively busy and noisy activity spaces. Solid partitions, dividers, glass walls, or planters can separate each section according to the need of these spaces. Activity spaces should include: 1) computers with internet access and allow families to access these computers to stay up-to-date with patient status and the outside world and 2) study carrels with health care information for families. There should be a media room to separate the television from the rest of the waiting area, so families who wish to have quiet and solitude are not disturbed. Families with children should be given spaces separate from a “quite zone” for adults only. A play area for children within the direct visual reach of the adult family members should be considered in the area designated for families with children. Some hospitals provide family sleep rooms with private bathrooms, kitchenettes and laundry in their waiting areas for family members who must stay at the hospital for an extended period.
Furnishings and Finishes. Furnishings in family areas should include comfortable seating for the family and the option of a wall-mounted fold-down bed or foldout chair-bed. Flexible furniture arrangements that allow families to change furniture layout to meet their needs are preferable. Unnecessary sources of visual stimulation should be minimized and wall furnishings should not be of bold patterns or colors that can be misperceived as threatening objects (e.g., bugs, animals) by patients or their families. Wall coverings and colors should be soothing and relaxing. In general, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff.
Nature, Spirituality, and Religion. Nature can have a positive effect on physical and emotional wellbeing; hence, it is preferable to design family areas with windows to the outside. If possible, these spaces need to be close to hospital gardens with plants, water, and other natural objects. When family spaces do not have a view of or access to nature, nature may be brought into the unit (e.g. potted plants, sound of nature, and nature related artwork). Hospitals also should consider outdoor labyrinths in gardens as a focus for spirituality. A working knowledge of common cultural and religious needs of patients and families is required to design family spaces. Sometimes, a focus groups with local spiritual and ethnic leaders before ICU design or re-design may help identify common design concerns of these groups.
Other Issues to Consider. Family spaces should provide easy visual or physical access to patient rooms so family members can see the patient. Families also should have easy access to caregivers when needed and know when caregivers are available in the unit. If the ICU design restricts family-care-giver interfaces, families may gather at places where they are likely to find caregivers.
In ICUs, staff-family communication can provide emotional, informational, and tangible supports to family members, and can facilitate family members’ involvement in patient care. Hospitals should consider the following to help improve family-staff interactions and communication: 1) Central nursing stations and glass partitions around staff area can limit family access to staff. 2) Decentralized nursing stations may provide more opportunities for a nurse to spend time in patient rooms. 3) Private patient rooms and well-designed consultation rooms may provide opportunities for confidential discussions. 4) Within hallways, alcoves can provide private spaces for confidential discussions. 5) Seating that is arranged side-by-side along family space walls can discourage social interaction. 6) Private and peaceful spaces can help improve communication. 7) In dim lighting conditions and in rooms with softer floor materials, people may interact longer.
Noise, music, art, lighting, odors and aromas are also important in family space. Carpeting in corridors next to family waiting spaces can reduce the impact of footsteps, rolling carts, staff member conversations, and other common noises in ICUs. High-performance sound absorbing materials can be used to reduce reverberation time, sound propagation, and noise intensity levels. Storage areas, staff lounges, and utility rooms also can be located away from patient rooms and family spaces to reduce noise. Internal corridors between storage and utility rooms can help clinical and support staff members perform necessary tasks without disturbing patients or families.
Sometimes, music can be used to mask distressing environmental noise that cannot otherwise be eliminated. Appropriate artwork can also help reduce stress among patient families. The choice of artwork and music needs to be sensitive to culture, religion, and the specific geographical area.
Appropriate lighting can influence mood or create a relaxed ambience. Therefore, attention should be given to make natural light available in all family spaces in the unit. When the family space is within the patient room, it is necessary to make sure that the intensity of natural light is comfortable to patients. A dynamic lighting solution that allows the color and temperature levels to be changed according to the time of day may be suitable for a patient room or a family space.
Pleasing aromas can help reduce blood pressure, slow the rate of respiration, lower pain-perception levels, improve the immune system, and help increase a sense of well-being among family members who are under severe mental and physical stress. In contrast, odors (“negative smells”) may stimulate anxiety, fear, and stress. Hospitals, particularly ICUs, are well known for their unpleasant odors or chemical smells. If possible, strong-smelling cleaning agents should be avoided near family areas. Aroma should be used with caution in ICU family areas.
In this section we discussed environmental design criteria for the ICU, the patient room, staff and support areas, and family areas of ICUs. While some of the issues discussed here will likely persist for the near future, others are being addressed by technical and process changes. For example, as manufacturers of medical equipment and supplies continue to merge and consolidate and develop standardized protocols for integration of medical equipment and devices, many interface problems related to technology that we see in ICUs today may be eliminated. Likewise, the evolution of information technology and medical informatics may soon make almost any data immediately available at any terminal device. As a result, communication among staff, patients, and families may improve significantly eliminating many medical mistakes attributed to poor communication. Further, many point-of-care testing systems may soon be able to provide accurate and real-time readings for numerous physiological parameters of ICU patients, all of which will then be automatically entered into the electronic medical record system. As a result, monitoring patient status and updating patient record may become a lot easier. Hospitals and designers must take note of these changing trends as they design the next ICU.
Society of Critical Care Medicine (SCCM). Guidelines for Intensive Care Unit Design. Critical Care Medicine. Crit Care Med, 1995; 23(3):582-588.
Hamilton DK (ed). ICU 2010: ICU design for the future, a critical care design symposium. Houston: Center for Innovation in Health Facilities, 2000.
Hamilton K, Shepley MM. Design for Critical Care: An Evidence Based Approach. Elsevier Ltd: Oxford; 2010.
Rashid M. Technology and the Future of ICU Design. Critical Care Nursing Quarterly. 2011; 34(4):332-360.
Rashid M. Environmental Design for Patient Families in Intensive Care Units. Journal of Healthcare Engineering – Special issue on critical care and intensive care unit. July 2010, 1(3), 367-397.
Rashid M. A Decade of Adult Intensive Care Unit Design: A Study of the Physical Design Features of the Best-Practice Examples. Critical Care Nursing Quarterly, 2006, 29(4), 282-311.
 The chapter is written based on chapter co-authored by the author for the book MONITORING IN NEUROCRITICAL CARE edited by Peter D. Le Roux, MD; Joshua Levine, MD; and W. Andrew Kofke, MD.
Intensive Care Unit (ICU) refers to a specific division of health care where specialized equipment and staff are required to monitor and treat critically ill patients. It wasn’t until the 1950’s when a man named Bjorn Ibsen became the founding father of intensive care and the leading man of the 1952 Copenhagen polio epidemic by manually ventilating a dying 12-year-old patient with polio.
Also see Heart Care
Specialized Types of ICUs:
Why is ICU design important? The following link gives Critical Care Statistics in the United States from the website of "Society of Critical Care Medicine" http://www.sccm.org/Pages/default.aspx