Healthcare Design - January 2014 - 62

R RESEARCH | 02.14
Simulating the NICU experience
Research and observation shaped the creation of a simulation lab that offers a
glimpse inside a single-family neonatal intensive care room
By Tammy Smith Thompson and Megan E. Denham
The Institute for Patient-Centered Design, a nonprofit
organization established to give patients and families
a voice in healthcare facility design, presented its
second annual Patient Experience Simulation Lab
(PESL) at the 2013 Healthcare Design Conference
(HCDconference.com). The neonatal intensive care
unit (NICU) was selected as the subject of the 2013
PESL, in order to explore benefits and challenges of

the literature and documented input from the team of
parents, clinicians, designers, and researchers. Every
product in the room was reviewed for its compliance
with the recommended standards, and design decisions were made based on research.

single-family patient rooms, a design choice many
new facilities are making to promote privacy, safety,
and family-centered care. In both physical and virtual
models, workshop participants took on the role of end
users in simulated activities that offered them an understanding of the varying scenarios patients, families,
and providers face. The PESL enabled participants
to experience the effects of design on functions that
take place inside these spaces, guided with input from
actual clinicians, patients, and families.
The Institute partnered with Nexxspan Healthcare, Turner Construction, WorldViz, Georgia Tech's
SimTigrate Design Lab, and more than 20 sponsors to deliver this project. It also worked with Hand
to Hold, a NICU parent support network, to better
understand the family perspective. The research was
led by SimTigrate, an interdisciplinary team dedicated
to driving healthcare innovation through the integration of evidence-based design and simulation. The
SimTigrate approach includes evaluating existing
evidence, testing solutions in simulated environments,
and validating solutions in a living lab, with the goal of
translating results for broader applications.
In spring 2013, the Institute released a call for design submissions in search of NICU spaces that would
enable families to remain with their infants and participate in the care plan. Design teams around the world
submitted both built and conceptual design projects.
A jury composed of NICU mothers, clinicians, architects, and researchers conducted a blind review of the
submissions, with the top-scoring projects inspiring
the design of the PESL model.
Many jurors also served on a content development committee, a team created to submit evidence
on NICU design and select the most relevant subject
matter for the simulation lab. Mardelle Shepley and
Robert White of the Consensus Committee on
Recommended Standards for Newborn ICU Design
led this charge, providing guidance from the committee's recent publication. SimTigrate's team reviewed

rect lighting was incorporated into the PESL model to
limit exposure to excessive light. To prevent disturbing
occupants who are trying to sleep at night, fixtures
were made to be adjustable and feature soft amber
light as well as a brighter white light for daytime use. A
procedure light was attached to the incubator to limit
its output beyond the field a user wishes to illuminate.
Lighting controls were made accessible to both staff
and parents at the headwall and by remote control. In
accordance with the recommended standards, the
headwall columns included a master switch for immediate lighting adjustment for procedures. The headwall
also provided the necessary infrastructure on each
side of the incubator for medical procedures, while an
angled design concealed utility outlets from the family
zone, a dedicated space with amenities to support
parent involvement.
The team introduced innovative products to
facilitate kangaroo care (holding the infant skin-toskin) and breastfeeding. They included an incubator
that can monitor temperature even when the patient
is being held and a bedside recliner with numerous
comfort settings that supports new parents in practicing kangaroo care even while sleeping. A foldable
table connected to the headwall provided a surface
for parents' items, and a disposable 18-inch panel
screen was created for skin-to-skin and breastfeeding
privacy without obstructing the parent's visibility of the
room. A breast milk refrigerator was selected for its
drawer design, which retains cold air when opened to
support temperature control. A warmer was chosen
for features such as its ability to warm breast milk only
as high as the body temperature of a mother, which
could not only protect the enzymes and proteins in
milk but could also prevent the overheating of plastic
containers and resulting leaching concerns.
Infection prevention is a critical concern in the
NICU, so sinks are an essential design feature to mitigate infection risk. A solid-surface sink was chosen
to meet recommendations for nonporous surface

HCDmagazine.com 02.14

The model
Because neonates have underdeveloped eyes, indi-

Tammy Smith Thompson

Megan E. Denham

http://www.HCDconference.com http://www.HCDmagazine.com

Healthcare Design - January 2014

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