Reflecting On NICU Trends – Achieving Flexibility with a Mix of Patient Room Types

Of the nearly 4 million infants born in the United States each year, as many as 15% will require intensive care. The projected rates of severe complications and birth defects continue to increase along with the demand for neonatal intensive care units (NICUs). It is essential that these spaces are designed to provide critical patient care along with compassionate experiences for the families and staff. 

NICU stays can be profoundly stressful events. Parents of babies admitted to the NICU experience substantially higher rates of anxiety and PTSD than other parents. NICU stays can disrupt a child’s biological and psychosocial development. Chronic stress and burnout are common among NICU providers. To combat stress, NICU designers must create an efficient, flexible, and positive environment that can sustain people through some of the most difficult days of their lives. 

In this series, we explore lessons learned from our post-occupancy evaluation (POE) of Kahler Slater’s design for HSHS St. John’s Hospital NICU. The full text of our POE findings is available here.

Private room
Semi-private room
Suite
Couplet Care room

Key Takeaways:

  • A mix of patient room types creates space for multiple care scenarios
  • Each patient room type offers distinct benefits and drawbacks
  • The value of any patient room type depends on the needs, preferences, and circumstances of the patient and their family.

The national trend in NICU design is all private rooms. This trend has gained favor because private rooms accommodate family needs, support complex patients, improve infection control and outcomes, and increase satisfaction. All private room units promote a sense of equality, since all families have equal accommodation. As acuity levels continue to rise, providing all private rooms is a smart future-proofing solution. However, to accommodate the diverse and ever-changing needs of NICU patients, family, and providers, a mix of patient rooms may provide even greater resiliency through flexibility.

At the start of the design, HSHS St. John’s Hospital NICU aspired to an all-private room unit. However, space constraints and emerging trends forced the design to leverage a mix of room types. Based on findings from our recent NICU Post Occupancy Evaluation, having a mix of room types is a compassionate and viable option to meet different patient and family needs while providing flexibility in day-to-day operations and long-term adaptability to meet rising censuses and acuity levels.

2020 FGI Guidelines assert that designing a NICU requires careful evaluation of patient, family, and operational needs to determine an appropriate mix of patient rooms. To achieve a welcoming, comfortable, and efficient space for all patients and families, that appropriate mix may include private, semi-private and Couplet Care rooms, and semi-open bays (suites).

Different Room Types for Different Needs

Each room type offers different benefits to patients and families depending on their unique needs and preferences. The private room that best suits the complex patients and families is not the best setting for the baby without family visitors, or those requiring observation during the family visit. Some mothers require postpartum care, which can separate her from her infant if no room can accommodate both their needs. Some babies come in pairs. From the family perspective, some appreciate the camaraderie and support from other parents, while others value their time alone. A mix of patient room types means that families can be cared for in the space best suited to their unique needs.

Achieving Flexibility to Meet Changing Needs

Flexibility comes from both a sufficient mix of rooms to serve a diverse patient population and the ability of rooms to be transformed into multiple different use types. Achieving flexibility requires thoughtfulness and a standardized approach to design.

The two most adaptable room types in HSHS. St. John’s NICU are the couplet care and semi-private rooms. These rooms have helped the NICU admit six sets of at once and allows it to regularly flex to accommodate high censuses – sometimes even accommodating surge patients from other units. While HSHS St. John’s Hospital NICU has had challenges in operationalizing the couplet care rooms, the rooms proved valuable for accommodating many other scenarios:

  • Healthy mom and sick baby
  • Multiples
  • Unrelated patients during high census
  • Mother / Baby Unit surge (healthy mom and healthy baby)
  • Palliative care. The larger room with a private toilet room accommodates additional family members and visitors and provides dignity to grieve.

By building flexibility into the NICU, our design delivered powerful results for HSHS St. John’s hospital and its community. As a Champion Firm for the Evidence-Based Design Accreditation and Certification (EDAC) program associated with the Center for Health Design, our goal is to enrich the industry with insights that help improve processes, designs, and outcomes. The full text of our POE findings is available here.

Room Types

Private Rooms

Private rooms are a best practice in neonatal critical care because they provide privacy for intimate care while also accommodating large teams and additional equipment during code events. These rooms provide the space and layout to care for the most complex patients along with extra space for families and visitors during long stays. There is strong evidence that private NICU rooms improve patient outcomes, reduce costs, and increase family satisfaction.

Semi-Private Rooms

Semi-private rooms allow multiples to be cared for in a shared space, while still receiving the benefits of a private room. These rooms can flex during high census events and provide space for unrelated babies and their families.

Couplet Care

Couplet Care rooms provide medical care to both the baby and mother, who may require postpartum treatment herself due to cesarean section or other complications. Sharing a room allows for parent and child bonding and intimate caregiving to occur in tandem with medical care and monitoring. There is substantial evidence behind this model of care. However, because Couplet Care requires cross-trained staff, it can be difficult to operationalize.

Suite

A Suite is a semi-private environment that provides patient bays within a shared environment. The relatively open area within the suite makes it easy for nurses and providers to monitor and move among the patients. It is also an ideal site for new staff training, due to staff proximity and ease of communication, as well as for volunteers coming in to provide nurturing care. The activity within the Suite can provide stimulation that benefits infant development for lower acuity patients. This environment is not suited for patients with numerous visitors or with complex needs.