The Future Pediatric Inpatient Unit

In this series, members of our core healthcare team discuss design philosophy and current trends in healthcare design.

The design of the pediatric inpatient unit is continually evolving with a variety of factors influencing the decision-making process. At the heart of a family-centered care design is the need to provide for the safety, comfort and well-being for the children and family to make their stay a positive experience. The young inpatient population will continue to trend toward more acute cases that are frequently chronic in nature. Further complicating the pediatric unit is the age range of the patient and the need to create a comfortable design aesthetic for children of all ages, from toddlers to young adults.

However, other considerations factor into the equation for the unit design, including technical and clinical innovations, the need to improve operational efficiencies, staff retention and stress levels, communication enhancement and support of the interdisciplinary team. There are a number of design trends and inventive concepts that have the potential to have a significant impact on the unit design and should be considered.

Patient / Family Space

The patient room design continues to advance ways that the patient can control their environment, especially pediatric patients. New wireless lighting controls can be synchronized to an application downloaded to the patient’s smartphone, making it effortless to turn on room lights or adjust brightness. Colors can be added to the LED fixtures so that accent colors may be added to the walls and ceilings.

Digital artwork is becoming more affordable, allowing patients to choose which images to view. Patient entertainment stations will continue to evolve to support not only TV viewing and gaming, but also web-based classrooms and educational tools.

Patient rooms are also increasing in size. Designated, separate family space for sleeping and working is needed that will not disturb the patient in the care zone of the room. Separate entertainment monitors may also become more common, which can be linked to personal hand held electronics. Parents also desire to have a sit-down table within the room to support activities with the patient and also to have meals with the family.

Pocket Parks
Outside of the patient room, more space is being allocated for families on the unit. A separate family lounge is a place where parents can go to de-stress while still maintaining close proximity to their child. At the new inpatient tower, currently being designed at Boston’s Children’s Satellite Hospital in Waltham, pocket parks are located within the neighborhood units to provide quiet spaces for family members, taking advantage of the natural light and views. These lounges will continue to evolve and may also include a resource center or a separate lounge for activities and entertainment for patient’s siblings. Common family support spaces will also be incorporated between units, including cooking kitchenettes and laundry facilities.

The design for Boston Children’s Hospital at Waltham incorporates “pocket parks” within the patient unit neighborhood

Dedicated outdoor and garden space for pediatric patients is also becoming more prevalent. The ability for children and their siblings to access outdoor play areas, such as a rooftop garden, under the supervision of the clinical staff, is being deemed a major design amenity.

Staff Space
The design trend for creating shared work space for the interdisciplinary team will continue to grow. Going beyond the shared conference or team room, team-based work centers will become more standardized in the unit. The interdisciplinary team will integrate more members as procedures and treatments are more frequently being performed at the bedside, increasing the demand for work area. Space for team consulting and rounding will become more important. At Boston’s Children’s Hospital Waltham, unit corridors are widened at the patient rooms, creating an entry porch to better accommodate the rounding team.

The team’s working environment drives the need for acoustical privacy. Team consultation will need to be mindful of HIPPA requirements and patient privacy issues. There will be a greater separation of on-stage/off-stage work space within the unit connected by staff-only corridors. No longer will all clinical staff gather at the nurse stations – dedicated private work zones with potential visual connections to the nurse stations will become more common.

The porch spaces at Boston Children’s Hospital Waltham are designed to facilitate daily rounds and interdisciplinary interaction adjacent to the patient rooms.

Flexibility
Healthcare in general is going through one of the most challenging phases in history with rising acuity levels, workforce shortages and aging nurses, rapid technology developments and changing patient care delivery processes. Space demand and configuration of the inpatient unit is different today than ten years ago and will likely change dramatically ten years from now. Any unit design today needs to be flexible, incorporating both adaptable and convertible concepts.

Flexible unit design allows for easy adaptation of the space from one use to another. This may include the standardization of patient rooms that can support a varied level of patient acuity. This also may include the ability to adjust patient care zones to accommodate staffing allocations or teaming either within the unit or across multiple units. Especially in urban hospitals, this may include vertical connections due to limited floor plates.  Additionally, greater use of furniture systems and demountable wall units are being considered to better accommodate rapid changes with minimal need for construction.

Convertibility of the unit means that the design is planned to facilitate future construction. This is particularly applicable in the core support area where the design can locate fixtures and infrastructure to perimeter areas leaving the center portion of the core area clear, reducing construction costs. Additionally, spaces within or adjacent to the unit are designated as soft space – administrative spaces that can be converted to clinical use with relatively minor construction.

Technology / Clinical Innovations
Rapidly advancing technology and the development of new clinical tools will continue to impact the inpatient unit design. The rapid rise in portable equipment enables more testing and procedures to be performed bedside, but also means that storage areas will need to be larger to accommodate more equipment. There will be a greater integration of advanced informatics including interoperability among data sources, middleware and the medical record, as well as the ability to merge data and process through computer algorithms to enhance trend analysis. Development of this technology and how it is delivered to the clinician is currently being evaluated. Additional slave monitors and hand held devices are both likely to be present.

The lab and pharmacy presence in the unit will increase.  Advancement in microfluidic technology is reducing the size of analyzers to hand-held devices, increasing the potential and effectiveness of point-of-care testing. In addition, the integration of pharmacogenetics and pharmacogenomics may potentially increase the need for dedicated pharmacy space in the unit to support changes in drug delivery.

Robotic design is evolving rapidly and new uses beyond transport systems are being developed. Prototypes for robots to support rounding, including remote rounding of specialists and rounding recording are already being tested. Additional robotic design includes clinical assistance such as patient lifts.