Rethinking the Traditional Intensive Care Unit

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Winter 2008
www.spacemed.com

BACKGROUND
Many hospitals feel that they never have enough intensive care beds and are constantly pressured to expand existing units or create new units. Historically, intensive
care units (ICUs) have provided intensive observation and treatment of patients in
unstable condition. Because of the high-tech requirements and highly skilled staff,
these units are expensive to build and operate. A lack of intensive care beds also
affects the ED, as high-acuity patients waiting to be admitted backup in the ED
when the ICUs are full.
CURRENT TREND
Healthcare organizations are redesigning ICUs to better monitor and care for patients, are improving nurse-staffing ratios, and are hiring specialists, known as
intensivists. Remote patient management of critically-ill patients is being successfully implemented in a number of hospitals around the United States in response to
shortages in nursing staff and intensivists, and the desire to improve the quality of
care and patient outcomes. Remote or virtual ICU monitoring centers can monitor
multiple ICUs at once from a remote location with real-time telepresence, including the review of clinical documentation and medical images, the monitoring of vital
signs, and the use of digital stethoscopes and high-quality video cameras. Use of a
remote patient management system, such as the eICU solution patented by
VISICU (www.visicu.com), allows scarce nursing and physician intensivist staff to
be more effectively leveraged 24-7 and can provide quicker identification of problems, faster intervention, improved outcomes, and lower operational costs. This
system also allows rural hospitals improved access to intensive care resources.
OPTIONS
With changing reimbursement, a shortage of specially-trained personnel, advances
in technology, and limited access to capital dollars for facility renovation or expansion, hospitals are looking for alternatives to the traditional ICU. Some options may
include the following:

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Acuity-adaptable patient rooms allow for staffing and equipment to be more

readily adjusted to meet the needs of patients, thereby eliminating unnecessary
transfers, potential overstaffing, and excessive treatment based on ICU protocols. Instead, critically ill patients, regardless of their location within the hospital, would be monitored remotely using the eICU concept.

Chest pain centers, typically located in or proximate to the emergency department, can provide extended observation and evaluation of patients complaining of chest pain and can eliminate unnecessary admissions to a cardiac
ICU.

Chronic ventilator units provide care for ventilator-dependent patients who

have been traditionally cared for in expensive ICUs because of the absence of
alternative facilities.

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Rethinking the
Traditional Intensive
Care Unit
Continued

Day recovery centers are alternatives to cardiac ICUs for patients requiring
cardiac monitoring for 12 to 24 hours following invasive cardiac procedures.

Extended recovery room hours accommodate surgical patients who require

12 to 24 hours of intensive post-operative observation prior to being transferred
to an inpatient nursing unit or discharged.

CONCLUSION
These alternatives can help head off the unfortunate situation in which a healthcare
organization builds additional ICU beds only to find that it is unable to staff them
due to recruiting difficulties in a tight job market.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

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