Jozef Kesecioglu

How should an ideal Intensive Care Unit

and Team be?

Florence Nightingale

keep critically ill patients together in one separate place for special nursing care

1852

First Intensive Care Units

many years later

■ specialized

personnel

■ mainly focused on

improvement of

illness

■ patients together in

special wards

New Intensive Care Units

developments

■ well being of

personnel and

safety procedures

documented

■ insight on mental

stress of patient

and family

modify procedures and

choose equipments

build upon needs of

patient and family

developments

First step in new design

define a vision

create the best

environment for

critically ill patients and

their relatives

environment allows

personnel to focus

on patient

Tools for improvements

interview former patients and their family members

create a mock-up room to test optimal functioning

Where to begin?

different approach

patient centered care

dictates architecture

and interior

functionality and safety

defines concepts

Patient

centered

care

Patient needs - private rooms

privacy

quiet

decrease infection

decrease medication

errors

improve family support

improve communication

increase satisfaction

Patient needs - natural light

day & night

reduce agitation

decrease stay

decrease pain

medication

reduce depression

Patient needs - feel at home

clock

armchair

lamp

whiteboard

soft colors

Needs of

the family

Needs of the family - areas for relaxation

PC with internet

cable TV

telephone

outside meeting space

own cafeteria

Needs of the family - signage/way finding

patient room numbers

directional signage

multilingual signage

way finding techniques

Needs of the family - visiting hours

24 hours visiting

bedrooms for family

Functionality

and safety

Functionality and safety - develop concepts

physician/nurse at

bedside or nearby

ergonomics

safety

Physician/nurse at bedside or nearby

“race track” configuration

with zones single room on periphery

of common corridor

decentralize care

outside view and natural

lightning workstation and window

between 2 rooms

Pysician/nurse at bedside or nearby

simple with minimal

alarms remote monitor at each

desk

selection equipment

evenly spreading of

personnel doors closed for quiet

atmosphere

Equipment according to concepts

select equipment that fits to the concepts developed

develop concepts after selection of equipment

NOT

Ergonomics

PDMS and equipment

off the floor

emergency access at

head of bed

ceiling service units

flexible positioning of

bed

Safety

patient alarms

logistics

pharmacy

Patient alarms and logistics

bleeper and smart

phone

24 hours supplies and

brought daily

daily change of drawers

Medication errors/adverse drug events

satellite pharmacy in

ICU

automated dispensing

devices

barcode medication

medication checked by

pharmacist

medication ready to use

Jongerden I.P. et al. Intensive Care Med. 2013; 39: 1626–1634

• Daylight

• Privacy

• Quiet atmosphere

• Family facilities

• Visiting hours

Jongerden I.P. et al.

Intensive Care Med.

2013; 39: 1626–1634

Intensive care unit environment may affect the course of delirium

Zaal IJ et al. Intensive Care Med (2013) 39:481–488

Conclusion

organization structured on needs of patient and

family is mandatory

develop concepts leading to architecture and

medical equipments

concepts as daylight, quiet surrounding, privacy,

ergonomics and safety will always be the future

materials, apparatus and building can get outdated

BUT

environment is an important factor in family and patient

satisfaction

single-room design improves satisfaction as compared

with an ICU with multiple beds on a ward

family and patient satisfaction with ICU experience

increases in an ICU environment consisting of noise-

reduced, single rooms with daylight, adapted coloring

and improved family facilities

Conclusion

Team

Open vs Closed format

Specialized vs Multidisciplinary

Workload

Nurses

Physicians

Background of physicians

Team

The risk of death was increased by:

3.5 (95% CI, 1.3–9.1) when the patient-to-nurse

ratio was greater than 2.5

2.0 (95% CI, 1.3–3.2) when the patient-to-physician

ratio exceeded 14

Neuraz A et al. Crit Care Med 2015; 43:1587–1594

Team

Open vs Closed format

Specialized vs Multidisciplinary

Workload

Nurses

Physicians

Background of physicians

© ESICM – Confidential document 48

TOPIC:

THE ART OF TRAUMA

RESUSCITATION

© ESICM – Confidential document 49

ESICM 28th Annual Congress