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quo in critical care design using evidence-based design. At one of the first
meetings, TMH team members made it clear they wanted to integrate
an onstage/offstage approach to separate public and private spaces. The
goal was to create an ICU environment that supports improved outcomes by decreasing sensory stress, not only by concealing staff work
areas but also by minimizing noise levels, maximizing visibility, and increasing natural light.
The resulting five-story, 346,270-square-foot ICU and surgery tower,
which opened in May 2019, modernizes the hospital's surgery suite and
adult intensive care units, creating a sense of place and a calming environment for people experiencing what's often an extremely stressful
time in their lives.
P R I O R I T I Z I N G PAT I E N T S A N D P R O V I D E R S

Prior to the new tower opening, data gathered from patients, families,
and staff on the former ICU identified three types of environmental
stressors within the space: sound, overall distractions, and room layout.
Sounds and overall distractions included alarms, equipment sounds, and
interruptions from visitors and medical staff, while stressors related to
room layout included room size, lack of computer access, and no visible
connection to the outside.
This feedback guided the design and planning of the new unit, which is
housed on three floors. Using the onstage/offstage design, each 24-bed
floor has a racetrack configuration, with beds organized into pods of eight
near three centralized nurses' stations. The longer, more linear layout was
a deviation from the former ICU's radial layout, which offered excellent
visibility but was noisy and lacked privacy. To address these concerns, as
well as the stressors identified based on input from TMH medical staff, the
design team included an internal corridor in the new layout to keep staff
and support activity away from patient rooms. Additionally, glass-walled
nurses' stations were chosen to minimize noise created by staff interactions while maintaining good visibility, as evidence supports the relationship between visibility and patient outcomes in the ICU. Decentralized
work niches throughout the unit also increase visual access by allowing
medical staff to quietly monitor patients through a window without entering the room as well as provide space for performing charting or other administrative tasks, further eliminating in-room distractions.
To address some of the environmental stressors related to layout, the
ICU patient rooms are designed with three dedicated zones: a staff zone,
a patient zone, and a family zone. The staff zone serves as a work area and
is designated by differentiated flooring, while the family zone is equipped
with outlets for charging devices, a reading light, window shade controls,
and a sofa that can be converted into a bed.
STUDYING DESIGN DECISIONS

After the M.T. Mustian Center opened in 2019, Gresham Smith's Healthcare Research and Innovation team partnered with TMH to conduct a postoccupancy evaluation to compare the campus' former ICU with the new
environment to better understand how the design impacted sensory stress
on patients and medical staff. To collect data from the new ICU after it was
occupied, the team used Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) scores and discharge surveys to measure patient perception of the ICU space; focus groups and turnover rates to
measure staff perception of the ICU space; and acoustical levels within patient rooms and nurses' stations to measure noise reduction. The data collected from both the old and new spaces was then analyzed by an external

MORE
ONLINE:
For additional
insight on how
this research
might be applied
to post-pandemic
ICU design and
to view images of
the Tallahassee
Memorial Hospital
project, visit
HCDmagazine.com/
TMH-project.

statistician using multiple regression analysis, a
type of statistical modeling that looks at the relationship between data points, revealing that
the total sensory stress in the new ICU tower was
significantly lower than in the old space. Specifically, the findings supported that the ICU's architectural elements, including acoustically rated
glass around nurses' stations, internal corridors
for noisy back-of-house support activities, and
decentralized work niches for patient monitoring and administrative tasks, successfully mitigate sounds and distractions.
Acoustic analysis showed that while the
quantity and types of sounds didn't vary from
the old to the new ICU, the overall acoustic
levels were lower around nurses' stations and
inside patient rooms in the new tower. For example, the new patient rooms measured 3 to 5
decibels lower than the old rooms, likely thanks
to the onstage/offstage layout and the acoustic
glass around the central nurses' stations.
Additionally, the staff reported that the decentralized nurses' stations enabled them to
block out unwanted sounds and focus more
closely on their patients while monitoring
them less intrusively.
The team also used a space syntax analysis to
analyze and quantify how staff experience the
longer layout compared to the former radial
floorplan. After applying a grid to the floorplan,
the software calculated correlations between
physical and visual accessibility, connectivity,
integration, and intelligibility and displayed
the results using a heat map to show high visibility to low visibility. The analysis revealed
that while the new ICU floors are nearly three
times longer than the old space, and therefore
the patient rooms are spread farther apart, staff
still had good visibility and walkability, lowering their sensory stress levels and enabling
them to care for their patients more easily.
Finding a balance between supporting efficient, safe processes and providing a comfortable, accommodating environment will be
essential to creating a cohesive ICU that supports patients and staff wellness. The activities
within the ICU are and will likely always remain
stressful due to the nature of critical care, but
evidence-based, human-centered design principles can create truly healing environments. 
Lesa N. Lorusso, PhD, NCIDQ, Allied AIA, is the director of research and innovation in the healthcare
studio at Gresham Smith (Jacksonville, Fla.). She
can be reached at L E S A . L O R U S S O @ G R E S H A M
SMITH.COM.

DECEMBER 2020

35


https://www.healthcaredesignmagazine.com/trends/operations-facility-management/stress-test/?hilite=%27Stress%27%2C%27Test%27 https://www.healthcaredesignmagazine.com/trends/operations-facility-management/stress-test/?hilite=%27Stress%27%2C%27Test%27

Healthcare Design - December 2020

Table of Contents for the Digital Edition of Healthcare Design - December 2020

Healthcare Design - December 2020
Editorial
Showtalk
Winning Comb Inat Ion
Wise Words
Cultivating Innovation
Hcd Virtual Review
Research Stress Test
Product Spotlight Seating
The Center
Face Time
Healthcare Design - December 2020 - Healthcare Design - December 2020
Healthcare Design - December 2020 - Cover2
Healthcare Design - December 2020 - 1
Healthcare Design - December 2020 - 2
Healthcare Design - December 2020 - 3
Healthcare Design - December 2020 - 4
Healthcare Design - December 2020 - 5
Healthcare Design - December 2020 - 6
Healthcare Design - December 2020 - 7
Healthcare Design - December 2020 - 8
Healthcare Design - December 2020 - Editorial
Healthcare Design - December 2020 - Showtalk
Healthcare Design - December 2020 - 11
Healthcare Design - December 2020 - 12
Healthcare Design - December 2020 - Winning Comb Inat Ion
Healthcare Design - December 2020 - 14
Healthcare Design - December 2020 - 15
Healthcare Design - December 2020 - Wise Words
Healthcare Design - December 2020 - 17
Healthcare Design - December 2020 - 18
Healthcare Design - December 2020 - 19
Healthcare Design - December 2020 - Cultivating Innovation
Healthcare Design - December 2020 - 21
Healthcare Design - December 2020 - 22
Healthcare Design - December 2020 - 23
Healthcare Design - December 2020 - 24
Healthcare Design - December 2020 - 25
Healthcare Design - December 2020 - 26
Healthcare Design - December 2020 - Hcd Virtual Review
Healthcare Design - December 2020 - 28
Healthcare Design - December 2020 - 29
Healthcare Design - December 2020 - 30
Healthcare Design - December 2020 - 31
Healthcare Design - December 2020 - 32
Healthcare Design - December 2020 - 33
Healthcare Design - December 2020 - Research Stress Test
Healthcare Design - December 2020 - 35
Healthcare Design - December 2020 - Product Spotlight Seating
Healthcare Design - December 2020 - 37
Healthcare Design - December 2020 - The Center
Healthcare Design - December 2020 - 39
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Healthcare Design - December 2020 - Face Time
Healthcare Design - December 2020 - Cover3
Healthcare Design - December 2020 - Cover4
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