Contemporary ICU Design

  • Diana C. AndersonEmail author
  • Neil A. Halpern


Intensive care unit (ICU) design is a complex process and requires a multidisciplinary group of professionals. It is highly probable that hospital-based intensivist leaders will be asked at some point in their careers to participate in efforts to design new ICUs or renovate existing ones. Four core principles should guide ICU-specific design. First, designing an ICU is a complex and time-consuming process. Second, an ICU is a semiautonomous mini-hospital. Third, the design requires balance between innovation and functionality, space and physical limitations, and desire and cost. Last, the design should combine technology, security, and healing. The layout of an ICU is arguably the most important design feature affecting all aspects of critical care services. While the core of the ICU experience is the patient room, central clinical support zones within the ICU act to bind the patient rooms and other supportive areas together, with the overall goal of supporting bedside care. Deploying advanced informatics into the modern ICU electronically integrates the patient with all aspects of care. This chapter provides an overview to a wide array of design issues and is divided into three sections: an overview of ICU design, configuring the ICU space, and future trends in ICU design.


Evidence-based design Intensive care unit Critical care Medicine Design Architecture Construction Built environment 


  1. 1.
    Halpern NA, Pastores SM. Critical care medicine beds, use, occupancy, and costs in the United States: a methodological review. Crit Care Med. 2015;43(11):2452–9.CrossRefGoogle Scholar
  2. 2.
    Halpern NA, Pastores SM, Thaler HT, Greenstein RJ. Changes in critical care beds and occupancy in the United States 1985–2000: differences attributable to hospital size. Crit Care Med. 2006;34(8):2105–12.CrossRefGoogle Scholar
  3. 3.
    Rashid M. Two decades (1993–2012) of adult intensive care unit design: a comparative study of the physical design features of the best practice examples. Crit Care Nurs Q. 2014;37(1):3–32.CrossRefGoogle Scholar
  4. 4.
    Redden PH, Evans J. It takes teamwork… the role of nurses in ICU design. Crit Care Nurs Q. 2014;37(1):41–52.CrossRefGoogle Scholar
  5. 5.
    Braun D, Barnhardt K. Critical thinking: optimal outcomes through end user involvement in the design of critical care areas. Crit Care Nurs Q. 2014;37(1):33–40.CrossRefGoogle Scholar
  6. 6.
    Ulrich RS, Zimring C, Barch XZ, Dubose J, Seo HB, Choi YS, Quan X, Joseph A. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61–125.CrossRefGoogle Scholar
  7. 7.
    Sadler BL, Dubose J, Zimring C. The business case for building better hospitals through evidence-based design. HERD. 2008;1(3):22–39.CrossRefGoogle Scholar
  8. 8.
    Halpern NA. Innovative designs for the smart ICU: Part 1: from initial thoughts to occupancy. Chest. 2014;145(2):399–403.CrossRefGoogle Scholar
  9. 9.
    Kesecioglu J, Schneider MM, van der Kooi AW, Bion J. Structure and function: planning a new ICU to optimize patient care. Curr Opin Crit Care. 2012;18(6):688–92.CrossRefGoogle Scholar
  10. 10.
    Thompson DR, Hamilton DK, Cadenhead CD, Swoboda SM, Schwindel SM, Anderson DC, Schmitz EV, St Andre AC, Axon DC, Harrell JW, Harvey MA, Howard A, Kaufman DC, Petersen C. Guidelines for intensive care unit design. Crit Care Med. 2012;40(5):1586–600.CrossRefGoogle Scholar
  11. 11.
    Hamilton DK, Shepley MM. Design for critical care: an evidence-based approach. Burlington: Elsevier Ltd.; 2010.CrossRefGoogle Scholar
  12. 12.
    Valentin A, Ferdinande P. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011;37(10):1575–87.CrossRefGoogle Scholar
  13. 13.
    Halpern NA. Innovative designs for the smart ICU: part 2: the ICU. Chest. 2014;145(3):646–58.CrossRefGoogle Scholar
  14. 14.
    Halpern NA. Innovative designs for the smart ICU: part 3: advanced ICU informatics. Chest. 2014;145(4):903–12.CrossRefGoogle Scholar
  15. 15.
    The Facilities Guidelines Institute. Guidelines for design and construction of hospitals and outpatient facilities. 2014 ed. Dallas: American Society for Healthcare Engineering.Google Scholar
  16. 16.
    Award Winning ICU Designs. How to build a better facility for patients and caregivers. 2013; 2014.
  17. 17.
    Evans J, Reyers E. Patient room considerations in the intensive care unit: caregiver, patient, family. Crit Care Nurs Q. 2014;37(1):83–92.CrossRefGoogle Scholar
  18. 18.
    Pati D, Pati S. Methodological issues in conducting post-occupancy evaluations to support design decisions. HERD. 2013;6(3):157–63.CrossRefGoogle Scholar
  19. 19.
    Cadenhead CD, Anderson DC. Critical care design: trends in award winning designs. World Health Design 2009; Available from: URL:
  20. 20.
    Rashid M. A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples. Crit Care Nurs Q. 2006;29(4):282–311.CrossRefGoogle Scholar
  21. 21.
    Pati D, Evans J, Waggener L, Harvey T. An exploratory examination of medical gas booms versus traditional headwalls in intensive care unit design. Crit Care Nurs Q. 2008;31(4):340–56.CrossRefGoogle Scholar
  22. 22.
    Maze C. Inboard, outboard, or nested? Healthcare design magazine 2009; (March 1, 2009). Available from: URL:
  23. 23.
    Drews FA. Human factors in critical care medical environments. Reviews of human factors and ergonomics. [8], 103–148. 2013. Human Factors and Ergonomics Society. Health-Care Human Factors/Ergonomics.Google Scholar
  24. 24.
    Hagerman I, Rasmanis G, Blomkvist V, Ulrich R, Eriksen CA, Theorell T. Influence of intensive coronary care acoustics on the quality of care and physiological state of patients. Int J Cardiol. 2005;98(2):267–70.CrossRefGoogle Scholar
  25. 25.
    Leaf DE, Homel P, Factor PH. Relationship between ICU design and mortality. Chest. 2010;137(5):1022–7.CrossRefGoogle Scholar
  26. 26.
    Lu Y, Ossmann MM, Leaf DE, Factor PH. Patient visibility and ICU mortality: a conceptual replication. HERD. 2014;7(2):92–103.CrossRefGoogle Scholar
  27. 27.
    Stroupe JM. Design for safety in the critical care environment: an evidence-based approach: considering the caregiver-patient-family experiences. Crit Care Nurs Q. 2014;37(1):103–14.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Medical PlannerStantec ArchitectureNew YorkUSA
  2. 2.Critical Care Medicine Service, Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations