TOPIC 1.1.
1 Management System and
Resources
ICU Physical Design
The Intensive Care Unit
• May constitute up to 10% of total hospital
beds
• Multidisciplinary ICUs require more beds
than single-specialty ones
• Large ICUs are divided into “pods” (8-15 px)
for clinical management
Intensive Care
• The practice of administering IMMEDIATE
and CONTINUOUS care to client with actual
or potentially life-threatening health
disorder:
 Brain injuries
 Cardiovascular Dysfunctions
 Pulmonary Dysfunctions
 Childbirth
 Shock and Trauma
 Infection and Sepsis
 Endocrine Abnormalities
 Multisystem Alterations
 Complex Surgical Procedures
GOAL of an ICU
• Create a healing environment
 Improves the physical and/or
psychological states of patients,
staff, and visitors.
 Helps to reduce medical errors
 Improve patient outcomes
 Reduce length of stay
 Increase social support for patients
 Cost-reducing
Layout of an ICU
• Should allow rapid access to relevant acute
areas
• Available, open, round-the-clock
communication lines between departments
• Safe transport of critically-ill patients
• Single entry and exit point with receptionist
• Areas dedicated to public reception, patient
management, and support services.
• Total floor area = 2.5 – 3 times the area
devoted to patient care
The High-Dependency Unit
• A specially staffed and equipped area
• Proved a level of between intensive and
general ward care
• Located within or immediately adjacent to
an ICU complex and are often staffed by the
ICU personnel
• Provides invasive monitoring and support
for patients with or at risk of developing
acute (or acute-on-chronic) single organ
failure.
• May act as a “step-up” of “step-down” unit.
Levels of ICU Care Provision
Level 1
• Small district hospitals
• Provide resuscitation and short-term
cardiorespiratory support.
 Mechanical ventilation
 Simple invasive cardiovascular
monitoring
• MAJOR ROLE: Monitor and prevent
complications of “at-risk” medical and
surgical patients
• Policies are established to determine which
patients require transfer and where they
ought to be transferred
 Established relationship with levels 2
&/or 3 units
• Certified intensive care specialist medical
director
• Some training and experience with critically-
ill children
Level 2
 • Larger general hospitals
• Provide a high standard of general intensive
care
 Multisystem life support
 With medical officer on site
 Access to pharmacy, pathology, and
radiology facilities at all times
• Certified intensive care specialist medical
director and majority of other specialists
• Patients admitted must be referred to the
attending intensive care specialist for
management
• Referral and transport policies with level 3
unit should be in place
Level 3
• Major tertiary referral hospital
• Provide all aspects of intensive care
management for indefinite period
 Committed to education and
research
 Complex investigations and imaging
and support by specialists of all
disciplines
• Staffed by intensive care specialists with
trainees
 Junior medical staff
 Critical care nurses
 Allied health professionals
 Clerical and scientific staff
Patient Care Zone
3-Zones Area:
1. Patient Care Zone
 Family Zone
2. Clinical Support Zone
3. Unit Support Zone
I. Patient Care Zone
• Patient Zone
 Single rooms for isolation –
equipped with anterooms for
handwashing, gowning, and storage
of isolation materials
 Suitable and safe air quality
 Negative-pressure ventilated
for contagious respiratory
infections
 HEPA (High-Efficiency
Particulate) filtration
 Each bed: Non-splash hand
wash basin (elbow/foot
operated taps), hand
disinfection facility
 Adequate and appropriate lighting
for clinical observation
 Patients should be able to be seen
at all times
II. Clinical Support Zone
• Adequate space for staff interaction,
mentoring, and socialization
• Houses:
 Central monitor
 Satellite pharmacy
 Drug Preparation area
 Satellite sterile and non-sterile items
 Communication (telephone,
computer, patients’ records,
reference books, and policy and
procedure manuals)
• Critical care is primarily at the bedside
III. Unit Support Zone
• Storage areas
• Separate clean and dirty utility rooms
• Laboratory Area 1: Facility for estimating
blood gases, glucose, electrolytes,
hemoglobin, lactate, and clotting status.
• Pneumatic tube or equivalent system to
transfer specimens to pathology
• Offices
• Washrooms
• Staff lounge
• Conference room
UHW ICU – Equipment at the Bedside