Considering delivery of critical services

Historically, cost has tended to be the main driver affecting specification of bedhead panels and ceiling-mounted pendants, which provide critical services for patient support and treatment.1 However, in recent years there has been increasing awareness of the need to improve understanding of the role of clinical factors, which should influence final investment.1 Although decision-making has tended to be driven by architects and health estates managers, there are some important clinical issues which need to be considered, which require input from the clinical team. These include:

• Flexibility to adapt to future theatre changes, evolving clinical demands and specialty interests.
• Provision of quick, efficient handovers from theatre to ICU.
• Unimpeded patient access when performing invasive procedures.
• Initiatives such as “lean thinking” and the “productive series”, which focus on ergonomics and efficiency – improving healthcare delivery, increasing “time to care” and reducing cost.

In view of the need for research into clinical considerations, a study comparing technologies in the ICU setting was conducted by James Thomas, associate professor of paediatrics at the UT Southwestern Medical Center, US.1 In collaboration with Debayjoti Pati and Jennie Evans, of HKS Architects, James Thomas highlighted the importance of understanding how different delivery systems affect the provision of care to critically ill patients and assessed both the role of family considerations and clinician preferences. An evaluation of intravenous tubing, electrical cords, medical gas tubing and organ support equipment was conducted within six simulated scenarios at the critical care service at Children’s Medical Center of Dallas. The scenarios included: patient admission, intubation, escalating organ support, “code blue” and CPR, surgery (for ECMO cannulation) and ECMO life support. The research highlighted the following: