Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

D Kirk Hamilton¹, Jodie C Gary², Elizabeth Scruth³, Harry L Anderson 3rd⁴, Charles D Cadenhead⁵, Simon J Oczkowski⁶, Vincent I Lau⁷, Jason Adler⁸, Adel Bassily-Marcus⁹, Benjamin S Bassin¹⁰, Joel Boyd¹¹, Katharina M Busl¹², James R Crabb¹³, Clifford Harvey¹⁴, Jason P Hecht¹⁵, Milee Herweijer¹⁶, Kyle J Gunnerson¹⁷, Abdullahi S Ibrahim¹⁸, Craig S Jabaley¹⁹, Lewis J Kaplan²⁰, Sarah Monchar²¹, Andrew Moody²², Julie Lindeman Read²³, B Christian Renne²⁴, Michael G Sarosi²⁵, Sandra M Swoboda²⁶, Kelly A Thompson-Brazill²⁷, Chris L Wells²⁸, Diana C Anderson²⁹

Affiliations

¹ Texas A&M University, College Station, TX.
² College of Nursing, Texas A&M University Health Science Center, Bryan, TX.
³ Northern California Safety, Quality and Regulatory Services-Kaiser Foundation Hospital and Health Plan, Oakland, CA.
⁴ Department of Surgery, Trinity Health Livonia, Livonia, MI.
⁵ Retired consultant, Houston, TX.
⁶ Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁸ Pediatric Intensive Care Unit and Pediatric Complex Care, Joe DiMaggio Children's Hospital, Hollywood, FL.
⁹ Department of Surgery, Icahn School of Medicine at Mount Sinai, Institute for Critical Care Medicine, Mount Sinai Health System, New York, NY.
¹⁰ Department of Emergency Medicine, Division of Critical Care, University of Michigan Health System, Ann Arbor, MI.
¹¹ Pulmonary Clinical Services, The Permanente Medical Group, Sacramento, CA.
¹² Departments of Neurology & Neurosurgery, University of Florida, College of Medicine, Gainesville, FL.
¹³ Mazzetti, Inc., Atlanta, GA.
¹⁴ Grand River Hospital & St. Mary's General Hospital, Kitchener, ON, Canada.
¹⁵ Department of Pharmacy, Trinity Health Ann Arbor, Ann Arbor, MI.
¹⁶ Wiegerinck Architects, Arnhem, The Netherlands.
¹⁷ Departments of Emergency Medicine, Anesthesiology and Internal Medicine, University of Michigan, Ann Arbor, MI.
¹⁸ Intensive Care Unit, Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁹ Department of Anesthesiology and the Emory Critical Care Center, Emory University, Atlanta, GA.
²⁰ Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
²¹ Division of Trauma Surgical Critical Care and Injury Prevention, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ.
²² Pulmonary/Critical Care, The Permanente Medical Group, Fremont, CA.
²³ National Patient Care Services, Kaiser Foundation Health Plan, Oakland, CA.
²⁴ Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
²⁵ Interventional Radiology/Department of Radiology, Trinity Health Ann Arbor, Ann Arbor, MI.
²⁶ Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD.
²⁷ Georgetown University School of Nursing, Washington, DC.
²⁸ Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD.
²⁹ Department of Neurology, Boston University, Boston, MA.

PMID: 39982130
DOI: 10.1097/CCM.0000000000006572

Practice Guideline

Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

D Kirk Hamilton et al. Crit Care Med. 2025.

. 2025 Mar 1;53(3):e690-e700.

doi: 10.1097/CCM.0000000000006572. Epub 2025 Feb 21.

Authors

Affiliations

¹ Texas A&M University, College Station, TX.
² College of Nursing, Texas A&M University Health Science Center, Bryan, TX.
³ Northern California Safety, Quality and Regulatory Services-Kaiser Foundation Hospital and Health Plan, Oakland, CA.
⁴ Department of Surgery, Trinity Health Livonia, Livonia, MI.
⁵ Retired consultant, Houston, TX.
⁶ Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁸ Pediatric Intensive Care Unit and Pediatric Complex Care, Joe DiMaggio Children's Hospital, Hollywood, FL.
⁹ Department of Surgery, Icahn School of Medicine at Mount Sinai, Institute for Critical Care Medicine, Mount Sinai Health System, New York, NY.
¹⁰ Department of Emergency Medicine, Division of Critical Care, University of Michigan Health System, Ann Arbor, MI.
¹¹ Pulmonary Clinical Services, The Permanente Medical Group, Sacramento, CA.
¹² Departments of Neurology & Neurosurgery, University of Florida, College of Medicine, Gainesville, FL.
¹³ Mazzetti, Inc., Atlanta, GA.
¹⁴ Grand River Hospital & St. Mary's General Hospital, Kitchener, ON, Canada.
¹⁵ Department of Pharmacy, Trinity Health Ann Arbor, Ann Arbor, MI.
¹⁶ Wiegerinck Architects, Arnhem, The Netherlands.
¹⁷ Departments of Emergency Medicine, Anesthesiology and Internal Medicine, University of Michigan, Ann Arbor, MI.
¹⁸ Intensive Care Unit, Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁹ Department of Anesthesiology and the Emory Critical Care Center, Emory University, Atlanta, GA.
²⁰ Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
²¹ Division of Trauma Surgical Critical Care and Injury Prevention, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ.
²² Pulmonary/Critical Care, The Permanente Medical Group, Fremont, CA.
²³ National Patient Care Services, Kaiser Foundation Health Plan, Oakland, CA.
²⁴ Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
²⁵ Interventional Radiology/Department of Radiology, Trinity Health Ann Arbor, Ann Arbor, MI.
²⁶ Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD.
²⁷ Georgetown University School of Nursing, Washington, DC.
²⁸ Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD.
²⁹ Department of Neurology, Boston University, Boston, MA.

PMID: 39982130
DOI: 10.1097/CCM.0000000000006572

Abstract

Rationale: Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.

Objectives: To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

Panel design: A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.

Methods: Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.

Results: The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

Conclusions: This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.

PubMed Disclaimer

Conflict of interest statement

Society of Critical Care Medicine (SCCM) required all guideline task force members to attest to a declaration of interest statement including all current and past financial conflicts of interest (COI) within 2 years before joining the guideline development process. No task force members reported any financial COI related to the development and writing of the guideline. All members were allowed to participate in all discussions and had equal weight in formulating the statements and voting. We allowed members to exclude themselves from discussion and voting around specific questions if they felt important academic COI. There was no input or funding from industry to produce this guideline. The COI forms are available from the SCCM and are updated on a regular basis. Dr. Anderson reports grant funding from the Alzheimer’s Association (AACSF-22-923724) related to the design of community spaces for older adults and innovation funding from Mass General Brigham related to ICU design and delirium; she received funding from Ovid BP. Dr. Oczkowski received funding from Fisher & Paykel. Dr. Bassin received funding from CannonDesign. Dr. Busl received funding from the National Institute of Neurological Disorders and Stroke and the National Institutes of Health (NIH) (U01NS124613 [AWD14238], NIH R01NS120924 [AWD10089]) related to management of headache for patients with acute subarachnoid hemorrhage in the ICU and the American Academy of Neurology; she disclosed that she is Associate Editor for Critical Care Medicine. Dr. Kaplan disclosed he is Chair, Scientific Review panel for the Congressionally Directed Medical Review Panel; a participant in a Centers for Disease Control and Prevention funded exploration of hospital room features to improve infection control; and he is a past-President of the SCCM, an Associate Editor for Critical Care Explorations, and an editorial board member of Critical Care Medicine. Dr. Gunnerson serves on the Council of the SCCM. Dr. Jabaley is an editorial board member of Critical Care Medicine and Critical Care Explorations. Dr. Swoboda serves on Board of American College of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest. A guidelines panel of 27 members with experience in ICU design met virtually from the panel’s inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.

References

1. Alhazzani W, Evans L, Alshamsi F, et al.: Surviving sepsis campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU: First update. Crit Care Med 2021; 49:e219–e234
1. Mikkelsen ME, Devlin JW: The A2F bundle: Quantity and quality matter. Crit Care Med 2021; 49:380–382
1. Guidelines for Intensive Care Unit Design: Guidelines/practice parameters committee of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1995; 23:582–588
1. Thompson DR, Hamilton DK, Cadenhead CD, et al.: Guidelines for intensive care unit design. Crit Care Med 2012; 40:1586–1600
1. Bass GA, Chang CWJ, Winkle JM, et al.: In-hospital violence and its impact on critical care practitioners. Crit Care Med 2024; 52:1113–1126

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Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

Affiliations

Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical