I just finished Mardelle McCuskey Shepley’s new book, Design For Pediatric And NeoNatal Critical Care. This book is hot off the press, published earlier this year. Mardelle McCuskey Shepley is a Professor of Architecture and Director of the Center for Health Systems & Design at Texas A&M University. We have the great privilege of having Mardelle speak at our class this fall (Oct. 14) at Stanford’s d. School. Her talk will be about the history of NICU design.
As far as I know, this is the first and only book on design for pediatric and neonatal care, an important contribution to the field of healthcare and design. I’ve found many studies about various issues in NICUs from sound pollution to infection control. However Shepley’s book brings all of those studies together into an organized, humanistic report with photos, graphs and tables that visually explain various experiments and their outcomes. The content is easy to understand for non-clinicians, and can be used as guide to help resolve design issues found in the NICU.
One of the most interesting studies I came across in the book was regarding the notion of private rooms in the NICU. Clinical staff members frequently express concerns that private rooms may compromise care or endanger their patients because of their perception of reduced staff visibility and greater distances to patients. Some staff members have mentioned that these new “family-focused” room may lead to accidental extubation rates. They have expressed that open-curtain bays are the safest physical model in which to provide pediatric or neonatal critical care because they believe they have greater visualization and awareness throughout the unit and can be at the patient’s bed faster when an emergency occurs.
A recent study by Laura Poltronieri and colleagues set out to explore the impact of private rooms on family behavior, staff patterns, and quality/safety measures. They found that with private rooms, the number of visitors and the durations of their visits were higher, nursing presence was higher, lengths of patient stays were shorter, and adverse events were fewer. In addition, single room mothers were more likely to breastfeed, single room infants had fewer apneic events, and staff reported less stress when attending single room families, albeit experiencing a perceived lower level of teamwork with their colleagues.
I find it fascinating that the fear surrounding something new: the idea of private rooms, was stirring up all kinds of negative reactions from clinicians, when in fact family involvement and patient outcomes proved to be better in such facilities when tested. Although the private room NICU design is a very positive model overall, cultural differences of families need to be taken into consideration when planning a new facility. Private rooms are not for everyone. A family with twins or multiples whose parents would like to be in the same room is an obvious example. Babies whose parents rarely visit may be another example (since they would receive limited vocal stimulus if in a private room). In addition, there are several cultures that think of being put into a private room akin to being put into solitary confinement. Culturally, privacy is not always valued as highly as being part of a community, even during breastfeeding or similar activities that many Westerners would prefer to do in private.
Therefore, the ideal NICU design would provide options: private rooms for families that live in the NICU, shared space for families who don’t visit often, and rooms that can accommodate 3-4 babies for parents who prefer to be around a few other families dealing with similar health issues.
I would highly recommend Design For Pediatric And NeoNatal Critical Care for anyone working in the NICU/PICU space (architects, clinicians, administrators, product designers and interior designers). We look forward to Mardelle’s talk this fall at Stanford.
-Jules