As the single room care model becomes the norm in Neonatal Intensive Care Unit planning and design, the single rooms can be arranged in a variety of configurations which have direct impacts on patient care delivery, operational efficiency and cost.
Parkin analyzed six of our single room care redevelopment projects from across North America. Each of the six projects employed a unique approach to the overall departmental floor plan and circulation patterns can be categorized as NICU ‘plan typologies’. Using urban and hospital planning terminology and conceptual diagrams, the various ‘plan typologies’ include ‘Centre Core’, ‘Spine & Cluster’, ‘Race Track’, ‘Cul-de-sac’, ‘Street and Block’ and ‘Double-Loaded Street and Block’. Common statistics and characteristics were gathered for each of the six ‘plan typologies’ to establish a base line for evaluation and an understanding of the site, program and project specific parameters which would affect planning decisions.
The arrangement of circulation corridors, entrances and exits, adjacencies to other hospital departments, care stations, support services, distribution of supplies, staff amenities and access to natural light and views varied considerably among the projects. The impact of less tangible design objectives – including culture, values, community, site and program – also played a significant role in the design and planning process.
Each ‘plan typology’ was assessed based on a common set of performance criteria including space allocations, circulation efficiencies (care-giver footsteps and separation of public and service circulation), infant and family comfort, privacy, safety and security, potential for future expansion, access to support services and availability of natural light and views for the infants (if desired), family and staff. A ‘scorecard’ type evaluation and qualitative analysis of each project resulted in comparative observations and qualitative assessments of each ‘plan typology’.
The example provided illustrates one of the ‘plan typologies’. Each example had project-specific variables such as program, acuity levels, regulations, site/building context and budget, making accurate and direct comparisons difficult. All six projects had single care rooms with a family sleep zone, provision for bedside charting, provision for charting near the room, supply cart in room (including medications), some form of patient monitoring and a high degree of control of sound, light and temperature in each room.
The following example from the Sunnybrook Health Sciences Centre in Toronto, Ontario is an example of a ‘double loaded street & block’ plan typology. Sunnybrook is a large urban campus teaching hospital and is a regional centre for neonatal care with a commitment to family centered care. The Sunnybrook model is unique from the other projects in that there is a separate corridor system for parents to access their baby’s room and meet the hospital caregivers ‘face to face’ at the bedside.
The project was a vertical addition to the M-Wing which was occupied in September 2010. It is a Level II/III NICU with nurse/infant ratios of 1:1 or 1:2. The NICU is one floor below the new Labour and Delivery unit with a dedicated elevator for patients and staff. Each room benefits from a direct observation chart desk with a decentralized work station in each cluster of rooms.
Conceptual Floor Plan
Upon review and analysis of the six plan typologies, it is apparent that there is no ideal plan configuration because each project is unique to its program, location and specific user care philosophy. It becomes a matter of establishing clear planning and design priorities and operational objectives.
In the Sunnybrook example, priority was given to a family-centered care model with secure family and visitor access segregated from staff and service circulation routes. Each patient area has a separate family entrance/zone and a medical/clinical entrance/zone. The segregation of the public circulation (family & visitors) from the service circulation (medical/clinical/support staff) circulation system enhances family comfort, safety and privacy, infection control and operational efficiency. As the unit is located on a large floor plate (originally designed to be fitted out with surgical suites), the patient rooms were moved ‘inboard’ within the floor plate which eliminates the option to bring natural light to the space (like the womb). The family and staff support spaces (lounges, offices, etc.) are located on the perimeter of the unit to provide and abundance natural light and views. The trade-offs in the ‘double loaded street and block’ configuration are a larger allocation of departmental gross floor area to circulation space, minimal natural light in the patient care areas and longer travel distances for staff.
Innovative planning and design which utilizes ‘borrowed’ natural light or decentralized support spaces to reduce travel distances can overcome the trade-off associated with a particular plan typology, resulting in an NICU layout customized to a hospital’s ambitions and objectives.