NICU Design Issues


Neonatal Intensive Care Unit Design Issues:

The complexities involved in the design of the Neonatal Intensive Care Unit are best addressed as a series of issues. These issues are expressed throughout the planning, conceptual, schematic, design development, documentation, and construction phases of the project, and each contribute significantly to the success of the completed unit.

Process:

The process of designing a successful NICU begins with a feasibility study. This analysis often involves the use of contemporary planning tools, including simulation modeling, to determine the infant capacity, room quantities and sizes, and desired inter-and intra-departmental adjacencies.
Caregiver/Infant/Family Zones

Following this study, plan proposals and cost-estimates are tested within the facility constraints. This phase includes various methods of supplemental research, inlcuding evidence-based design references, site-visits to similar facility models, family and staff input, benchmarking research, etc. Because modern NICU design includes several innovative planning and design concepts, it is often necessary to address each of these methods in order to select the most appropriate model to support the unique needs of the staff and families specific to the particular project.

With the validation of a specific program layout, the schematic phase is begun. This phase often involves the use of full-scale mock-ups, although these models are more frequently used in the following design-development phase. In this phase, the mock-up allows for dimensional adjustments and various simulations of selected equipment and interior materials, which will ultimately be tested by the environmental services staff for durability and ease of maintenance. It is not uncommon for families, physicians, nurses and additional staff to simulate the use of this full-scale model in order to mold its dimensions, equipment configuration, and zoning to suit the needs of the staff, the infant and the family. It is important for the staff to understand the necessary distinction between caregiver work space, infant care space, and family space within the NICU so that they might appropriately use the space according to its intentended use (pictured right).

'Pod' versus 'Private-Room' Models:

NICU Design Issues - Health ArchitectureThe primary planning decision of the present moment concerns the selection of the traditional 'pod' model or the recently developed 'private-room' model (pictured right). The traditional pod model is frequently selected for its staffing efficiency, staffing socialization provisions, minimal square footage requirements, and window-wall provisions. However, recent developments in evidence-based design suggest that the private-room model sufficiently supports the needs of infants and family members. With advances in staff communication systems, electronic charting, the ability to link neonate monitors with staff communication systems, and staff locators, hopital decision-makers have become more comfortable with moving toward the private-room model.

The private-room model evolved from initial efforts to control infectious diseases among infants by providing one or two isolation rooms per unit. Over time these rooms were used to accommodate both infants and families with unique needs, eventually initiating the single-room trend among renovated facilities.

With the decision to use the private-room model comes a series of supplemental planning issues. The most significant among these concerns the social needs of staff. The private-room model requires individual staff to attend to pods of approximately ten private rooms. In order to efficiently visualize each infant care space, the nursing staff needs decentralized monitoring stations, in addition to the use of electronic monitoring capabilities. In order to support the social needs of the nursing staff, several facilities have included both centralized and decentralized stations within the private-room model.
Stormont-Vail Family Space
The private-room model is specifically praised for its provision of family services. Within the patient room the family is provided space to monitor the infant and space to rest. Without the room the family is supported with additional spaces, including restroom, dining, computer, breastfeeding, lounge, and social spaces. It is important to note that increased privacy within the patient does not indicate a lesser need for social space within the NICU (pictured right). The privacy and sleeping accommodations attempt to provide the family with a 'homelike' environment, similar to the 'room-in' concept following delivery.

In order to minimize staff travel time between single-patient rooms, an innovative approach has been developed regarding acuity accommodations. By designing a 'universal' room to provide spatial and equipment needs for all (or most) levels of acuity, nurses may be evenly distributed throughout the unit to dedicate sufficient time and attention to infants requiring varying levels of acuity, assuming the nursing staff is trained to support all levels. Within this room, equipment, installations and furniture will be placed in identical locations to similar rooms in order to ensure accuracy and save time.

Environmental Stress:

Recent developments in evidence-based design and scientific studies have suggested significant infant stress induced by the NICU environment. With this new body of knowledge, designers have become increasingly aware of the impact of design decisions on the sensory environment. In order to reduce infant stress and avoid developmental issues, consideration has been paid specifically to the areas of light, noise, and temperature control within the NICU.

The early development of the Circadian rhythm begins in the NICU; thus it is important for contrasting lighting conditions to occur according to time of day, often requiring enhanced 'daylighting' with artificial light or forced darkening of the windows. Literature suggests that low illuminances are important to near- and long-term development of premature infants. However, the evidence supports the opposite conclusion for adults in the same hospital environment. Although high illuminances are necessary for staff performance, the concern for infant well-being far exceeds that of the staff. The ideal solution would include accommodations for both the staff, families, and infants. Additional lighting suggestions include the avoidance of large bays of fluorescent lights, the addition of rheostats to electric lights, the provision of additional lamps for staff use when natural light is limited, and special consideration for potential heat loss or gain through windows.

Early infant development is stifled by excessive external stimulation, frequently induced by excessive or even slight noise. Attempts to dampen unnecessary noise include the inclusion of textures, carpet, ceiling tiles, silent alarms, and quiet equipment.

The NICU should include controls to regulate the temperature, by eliminating draft and maintaining a stable temperature despite external conditions. In order to reduce mechanical noise and evenly disperse airflow throughout the NICU, perforated vents have been introduced in the form of diffusers spaced among the acoustic ceiling tiles.
diffuse, interior themes

With the advent of environmental considerations, including the private room model, results indicate the increased ability of infants to conserve energy, improved ability to manage their environment and growth, decreased respiratory support, decreased lung disease and decreased length of stay.

Advancing Technology:

The consistent evolution of technology is directly evident in the frequent replacement or addition of equipment within the NICU and individual patient care areas. This continual growth raises issues in appropriate charting locations, storage accommodations, communications technology, etc. With the ability to transport electronic charting amongst infant care areas, nursing staff has adopted both bedside, decentralized, and centralized charting methods. Storage accommodations are met in three tiers: bedside, unit-based, and centralized. It is important to consider advancing equipment models that will need to be stored in the future. Communications technologies have enabled the private-room design, and raise question as to whether or not staff needs to have all eyes on each infant during all hours of the day. As these technologies progress, security has increased within the NICU.


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