Decentralization: The Corridor Is the Problem, Not the Alcove.

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.

Hospital Building and Departmental Area Calculation: Comparison of 36 Recent North American Projects.

BACKGROUND: Hospital trustees, administrators, and their consultants must base important budget decisions upon a projection of the size of proposed construction projects. The anticipated functions and an estimate of the space required are generally provided in a project program or project brief. The programming consultant, often part of the architect's team, will calculate the physical area (square feet or square meters) required to perform the desired functions based on an understanding of demographics in the service area, services offered, the volumes of service required, and a historical understanding of space required to perform those services. Hospitals and hospital designs in North America have been changing. Plans must now address far higher percentages of outpatient care, accommodate new equipment modalities, and provide space to account for family presence in patient rooms. AIM: A study was undertaken to better understand whether the allocation of space in recently constructed hospital projects is different from the amounts of area devoted to various departments and functions in older projects. METHOD: In order to assure measurement consistency, a measurement methodology was developed and is reported elsewhere. Thirty-six recently constructed hospitals were measured. RESULTS: The results provide new information about the allocation of space for nondepartmental functions within the overall building gross calculation. Many of the departmental space allocations fell within an expected range. Ultimately, significant detailed information about hospital area calculations is made available to the public because of this study.