Creative design thinking in bed space for ICUs

The practice of medicine is becoming increasingly reliant on knowledge, expertise and technology from interdisciplinary fields that were traditionally considered alien to the domain.

This is especially so in complex and advanced specialties such as intensive care, where practitioners frequently encounter the need to use multiple devices and equipment to support a critically ill patient.

The number of such devices that populate a typical intensive care bed space is multiplying every year. They range from organ support devices such as ventilators and dialysis machines to monitoring systems to clinical information systems.

The advent and usage of such systems have made it possible for many patients to recover from complex and serious illnesses, which would have not been possible without those systems. They have also made it possible for the physicians to detect deterioration early and address them in a timely fashion.

However, there is an alarming lack of integration among these various bits and pieces of equipment despite their individual sophistication. This leads to a possible lack of efficiency and even potential harm to patients and their caregivers in certain circumstances.

A typical ICU patient is surrounded by at least 12 different pieces of equipment which cause clutter and restrict access to the patient in emergency situations, in addition to being a potential occupational health hazard.

The individually sophisticated systems were designed to fulfil their own roles without much consideration being given for their interaction with the patient, caregivers and other equipment in the patient’s vicinity. For instance, a dialysis machine is not particularly designed to take into account the ventilator tubing which might be in its vicinity in the ICU bed space.

The authors facilitated and supervised an observational study titled “Observation and analysis of ICU designs” that won an international design award for University of Canberra industrial design masters students Hugh Stehlik and Blake Fenwick.

The study observed existing ICU designs and proposed an integrated ‘concept ICU bed space’.

The authors are currently involved in the design and development of the integrated patient care environment (IPCE) for intensive care units in addition to a design-centric approach to developing a novel fluid-monitoring system for use in the ICU.

Integrated patient care environment

The advancement in ICU organ support and monitoring is analogous to the evolution of computing technology. Lessons can be learnt from computing technology, which faced a similar bottleneck in its early years because of individually sophisticated elements being connected in a complex, unreliable and inefficient manner.

Today’s modern, efficient and reliable microcomputers and smartphones would not have been possible if the computing world did not take this problem of lack of integration seriously. The idea that transformed the industry is called very-large-scale integration (VLSI), which is the process of creating an integrated circuit by combining thousands of transistors into a single chip.

It should be acknowledged that although the diminutive scale of microprocessor design and the relative linearity of electronic systems made this feat achievable by reducing redundant circuits and connections, the same degree of integration may not be possible in a large structure like ICU.

Nevertheless, the problem that led to the conception of the design idea has a striking similarity to the problem that the modern ICU faces – lack of integration, redundancy, unreliable connections, inefficient and error prone systems. And the design solution that it points to has a lot of similarities.

An integrated patient care environment (IPCE) as an alternative to an ICU bed space could be developed with our concept in mind. Such IPCEs could help formulate the design rules to develop the equipment and devices around the patient in the short and medium-term future.

This is as opposed to the patient’s bed space being tailored for manufactured devices. Many pieces of equipment with redundant systems (electrical transformers, mount systems, motors, digital signal processors etc.) could be designed to share a common platform. This would potentially lead to much leaner, efficient, space-efficient and cost-effective design of organ support systems.

Energy sources could be integrated into the IPCE design thereby avoiding the plethora of chaotic cables. Such IPCE design would require coming together of a large number of individuals from various domains ranging from bedside specialists to equipment designers.

A ‘design-centric’ approach to product development, whereby an innovative concept is developed from the outset with human factors in mind as opposed to a plain engineering approach, will help achieve such goals. With this in mind, the authors are involved in developing an IPCE for intensive care units which aims to replace the many devices and equipment with one holistically designed unit.

It is imperative that the problem of lack of integration be understood as a significant one, both in the ICU and other specialties. Although objective data regarding the implications of existing unintegrated, non-patient centric designs is lacking, it is obvious that such systems are prone to inefficiency, unreliability and even potential for harm.

Inter-disciplinary domains such as industrial design, user-experience design and engineering have a lot to contribute to the development of a futuristic, integrated and patient-centric ICU design.

Such design could promote innovation and advancement of existing systems while at the same time could improve the efficiency of the ICU bed space. This could potentially be translated to better patient outcomes and improved cost efficiency.

We would appreciate inquiries for collaboration in development and participation in further research into this novel concept from interested individuals or entities.

About the authors

  • Dr Balaji Bikshandi, intensivist and VMO, Dubbo Base Hospital, NSW. This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Associate Professor Carlos Montana Hoyos, convenor, industrial design, Faculty of Arts and Design, University of Canberra
  • Dr Stephen Trathen, assistant professor, industrial design, Faculty of Arts and Design, University of Canberra
  • Associate Professor Frank Van Haren, intensivist and director of research, ICU, Canberra Hospital.

Posted in Australian eHealth

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