Over the past century, the development of the Neonatal Intensive Care Unit (“NICU”) has played a significant role in reducing the infant mortality rate. Before the first NICUs were built, premature and sickly babies were simply sent home with their families and assumed to be lost causes. Today, babies who are born at a gestational age of just 23 weeks have a fighting chance not only to survive but to thrive.
NICU design has evolved over the past 60 years—in both its practices and healthcare architecture—so that today both parents and babies receive care that improves infant outcomes and promotes care and bonding. Recently, Parkin’s EDAC team participated in two intensive workshops to re-imagine NICU design.
A Brief History of the NICU
The earliest neonatal care during the 20th century didn’t happen in hospitals. In the US, early isolettes were funded by visitors to Coney Island who paid admission to see babies in care! It wasn’t until the 1960s, after Louis Gluck designed the first neonatal intensive care unit, that hospitals started to make NICUs an established part of hospital care.
As technology advanced, neonatal care has become more parent-friendly. Skin-to-skin care is encouraged when possible, for mothers and babies to bond. Fathers and older siblings are now a part of the larger caregiver team and are able to visit and help care for babies along with mothers and clinical staff.
Families caring for sickly or premature babies are under extreme stress and the NICU often becomes a second home—for months at a time. The design of neo-natal care, therefore, plays a crucial role in the support of families and babies.
In the past, our team attended these workshops in person; however, due to COVID protocols, we moved to a virtual model. This allowed designers to team with neonatal intensive care clinicians and parents, to innovate and think “big” about how to improve the healthcare architecture required to care for this critical patient population.
Workshop participants used Miro boards and were asked to empathize, define, ideate, and prototype/test with groups of physicians, patients, nurses, architects, and designers to brainstorm NICUs of the future and how those ideas could inform changes to the Federal Guidelines Institute (“FGI”) code on NICU design.
Twelve teams were formed with each group starting with a “How might we” statement of what we wanted to investigate further and try to improve in the NICU. Our aim was to recognize how past assumptions caused flaws for earlier NICU design and to challenge our present-day assumptions for better design in the future.
Some teams focused on NICU Neighbourhood design, considering pods of rooms, the organization of NICU patient rooms, and subsequent support areas.
Some teams touched on the inside of the NICU patient room design with some overlap as they also looked at neighbourhood design.
Others focused on technology and structural implications.
Each of the 12 teams presented its ideas and prototypes. In a subsequent 2.0 workshop, three “super teams” took each of the three topics further. Across the two workshops, we considered a broad spectrum of questions aimed at delivering better care for families throughout their interaction with the NICU.
We asked ourselves, “How might we:”
● Prioritize the family unit as a patient in the NICU?
● Ensure family privacy in the NICU while creating an enhanced sense of community?
● Provide a private space that is nurturing for the families and babies while still providing access to necessary clinical care?
● Minimize the effect of PICS (post-intensive care syndrome) and promote positive family dynamics and inclusion?
● Accommodate the growing equipment needs in the room as the baby’s condition continues to improve towards discharge from the NICU?
● Achieve both interaction and intimacy at all levels of the NICU for infants, families, and staff?
● Improve connectedness and communication between the care team and family members in the NICU?
● Foster family-to-family and family-to-staff relationships?
● Create an individualized family-centred approach from arrival to departure?
● Empower families to manage their privacy and connectivity in a way that helps clinicians with care delivery?
● Enhance coaching role (of clinicians) supporting the long-term success of parents caring for babies (in the home)?
In the end, the outcomes from both workshops will be used to provide possible changes to the FGI requirements on NICU’s design.