MORGAN STANLEY CHILDREN’S HOSPITAL OF NEW YORK

Pediatric Critical Care Research Study

The PICU is a central and vital component in all comprehensive acute care children’s hospitals. Changing physical models, specifically private patient/family rooms are being planned for and designed to address issues of family focused care, patient privacy, sound and infection control. These emerging physical models, and the new communication and monitoring technologies which make them possible, are also posing challenges and raising concerns of clinical staff members at children’s hospitals worldwide. For these reasons Poltronieri Tang & Associates has developed and sponsored a multi-year multi-phase research study of the PICU environment. Identifying which design factors aid or hinder patient safety and appropriately balance the needs of families for increased involvement with that of effective clinical care delivery are essential. The health, well-being, and recovery of patients, make an understanding of these new PICU design models essential.

The current evidence based design research study evaluates three separate PICU’s all within the same academic children’s hospital. Each unit has significantly different spatial and environmental characteristics. The compares and contrasts the differing unit configurations, their physical layouts, space allocations, and functional relationships. The data collected quantifies the correlations between these environmental factors and measurements of: family and patient satisfaction; patient safety and outcomes; and staff efficiency and satisfaction. The results of this research are intended to guide and inform the detailed physical planning and design of PICU environments worldwide. It will provide a detailed and quantified understanding of the environmental design factors that have an impact on the pediatric intensive care setting.

Unit typologies being studied include:

• A 12-bed open bay unit, with cubicle curtain separation

• A 13-bed unit with glass enclosed rooms, sliding front and side walls

• A 14-bed unit with enclosed rooms, with sliding glass fronts, solid side partitions, and decentralized room-side nursing stations

The differing unit configurations, their physical layout, size, space allocations, and functional relationships have been measured, categorized, and assessed. Additional factors including mechanical systems, acoustics, amount of daylight, etc. have also been noted. Each unit is evaluated against measurements of patient/family satisfaction, staff performance and satisfaction, as well patient safety and outcomes.

Some questions central to the study include:

• Do families in private rooms spend more time at bedside?

• Do families in private rooms perceive they are getting better care?

• Do private room PICU models require additional staffing?

• Do clinical care staff members spend more time at bed side in private room models?

• Do self-extubation rates differ between unit designs?

• Do infection rates differ between units?

• Does acuity adjusted ALOS differ between units?

The three units are being measured and evaluated through numerous research methodologies, including:

• A comprehensive physical inventory of all potentially relevant environmental characteristics.

• Structured observations of all three units 168 hour period. These observation sessions are tracking the frequency and length of caregiver/ patient, caregiver/ family, family / patient, and family/family interactions.

• Five years of patient and quality control data are being evaluated including: patient outcomes, self extubation rates, infection rates, lengths of stay, medical errors, staffing patterns, etc.

• Custom designed family and staff feedback questionnaires are also being administered.

The availability of three distinct PICU’s within one children’s hospital affords an incredibly valuable opportunity to evaluate how these distinctly different environments impact quality of care. We are anxious and excited to share our findings with the broader PICU clinical care community in order to further refine our recommendations and conclusions. This research study will determine how specific PICU planning and design details influence patient outcomes, as well as staff and family satisfaction and set new benchmarks for the design of PICU’s.