Glasgow Royal Infirmary, Glasgow, 2011. Reiach and Hall architects, intensive care unit.
Four zones can be distinguished in the ICU: the patient care zone, the clinical support zone, the unit support zone and the family support zone. ‘Glass partition walls to facilitate surveillance and certain medical equipment have to be installed in an intensive care unit, but designers should try to make them as homely as they can, using natural materials and colors to soften the harshness of the environment they normally provide.’137 Perspective of the Patient Patients in ICUs are closely monitored at all times, drugs are administered if needed, and personnel — medical specialists and a specialized, dedicated nursing staff — are at hand to come to the rescue in case of calamities. ‘The ICU is the stage for many of life’s most extraordinary dramas’, to quote Kirk Hamilton who has researched the design of intensive care units.138 It is, however, a misconception to think that patients do not experience their time in the ICU intensely. Swedish studies have shown that ICU patient spend on average around 60 % of their time (during daytime) in a conscious state. Design efforts in intensive care must therefore pay careful attention to the patient’s needs. There is a point to that, however, because the design and function of ICUs cause a lot of unintended and unnecessary harm to patients who stay in them for durations longer than 14 days. Studies indicate that around 30 % of long-term ICU patients develop posttraumatic stress disorder (PTSD), which diminishes the patients’ ability to return to a balanced life and/or the ability to work again.139 Conditions with a negative impact on patient health are: •C ontinuous disorientation •C ontinuous illumination •E xposure to extreme noise (frequently higher than 60 dB on average)140 •S leep deprivation • Loss of control combined with abundant alarm functions (the latter give the patient the continuous impression of being in a life-threatening situation). Considering the goal of intensive care, namely to keep the patient alive, the design of such facilities must be significantly improved in order to prevent further collateral damage to patients. Early mobilization and reactivation while the patient is still in the ICU has been shown to have a positive effect on his or her health. Studies show that mobilization, including moving the still-ventilated patient, and even mobilizing the unconscious patient, may lead to an average reduction in the length of stay for long-term patients of 1.0 days in the ICU and 1.5 days in general inpatient care. This is not only a significant cost factor but 101