Authors: Oystein Tronstad, Dylan Flaws, John Fraser, Sue Patterson
Event: 2019 TheMHS Conference
Subject: ICU of the Future - how redesigning the ICU environment can improve patient outcomes.
Type of resource: Conference Presentations and Papers
Stein is a physiotherapist with a special interest in patient-centred care, investigating how the multidisciplinary
team can maximise short and long-term recovery of ICU survivors. He is currently leading a
project investigating how the ICU environment and design is affecting patient outcomes, aiming to redesign
the ICU bed-space.
Dylan is a psychiatry registrar. The EDACS score, produced as part of his PhD, is standard practice throughout
New Zealand. He was awarded a Junior Doctor Research Fellowship, and the Metro North “Rising Star” Junior
Researcher of the Year. He is now collaborating with the CCRG to reduce ICU delirium.
Intensive Care Unit (ICU) survival rates have increased significantly, however survival sometimes has a cost.
Survivors commonly have ongoing physical, cognitive and psychological complications, including a much
higher prevalence of depression, anxiety and PTSD than the general population, and many never return to
their premorbid level of function. Delirium, an acute confusional state experienced by up to 80% of people
admitted to ICU, substantially increases the risk of PTSD, reduced cognitive functioning, and other long-term
mental health problems. With robust evidence demonstrating that the noisy, bright and busy ICU
environment negatively affects patient recovery, experience and longer-term outcomes, it is critical that the
environment is improved.
This presentation describes a ground-breaking project combining the technical expertise of designers and
experience-based knowledge of clinicians, patients and their families to co-design an improved and
innovative ICU bed-space aiming to fundamentally redesign the environment to not only achieve survival,
but provide a superior hospital experience, optimised outcomes of care and quality of life beyond. We
describe the process of co-design and outcomes from the mixed-methods research integrated in the
project, highlighting learnings of relevance to mental health inpatient settings.
Learning Objective 1: Attendees will learn about the mental health complications most commonly seen after
an ICU stay, how the physical environment and patient experience contributes to these complications, and if
anything can be done to prevent this.
Learning Objective 2: Mental health complications during and after an ICU admission are often poorly
assessed and diagnosed, and therefore many former ICU patients are not receiving adequate follow up and
treatment for their condition. This will help highlight the most common complications seen in this patient
cohort. Also, some of the strategies to prevent these in an ICU setting might also be applicable in other
hospital environment, such as mental health units.
Zaal, I.J., et al., A systematic review of risk factors for delirium in the ICU. Crit Care Med, 2015. 43(1): p. 40-7
Desai, S. V., et al. (2011). "Long-term complications of critical care." Critical Care Medicine 39(2): 371-379.