Hospitals recognize the importance of individualized space for newborns and their families.
The nurses at Meriter Hospital (Madison, Wis.) were apprehensive when a steering committee considered converting its ward-style neonatal intensive care unit (NICU) to single-family rooms. The existing unit included two large rooms, each capable of accommodating 12 or more babies. The new design would incorporate 23 individual rooms, with a total of 30 beds.
Their concerns were legitimate, says Dare Desnoyers, Meriter newborn intensive care unit nurse manager. They wondered if it was realistic to monitor so many babies in separate rooms. Would it be possible to keep track of supplies and adapt to new technology? And, equally important, how well would they adjust to being separated from their colleagues, and instead, care for patients in individual rooms? “It was a huge transition for our staff, and there was some anxiety going into this,” says Desnoyers. “But, today they wouldn’t go back to the old way.”
Meriter is one of a wave of hospitals that have carved out private spaces for families and their babies. Instead of being subjected to bright hospital lights and a room full of noisy monitors and ventilators, critical newborns can remain with their parents and visiting siblings in a gentler environment where lighting is adjustable and noise is subdued.
Brainstorming the project
“In the old unit, we were very crowded at times,” says Desnoyers. “Just because babies are small, it doesn’t mean you don’t need a lot of space for their equipment, such as incubators and monitors.”
The board of directors at Meriter agreed. “It wasn’t a hard sell for the hospital,” says Desnoyers. “We knew we had a certain amount of space. It was more an issue of determining how many beds we could accommodate.”
The steering committee in charge of planning the new neonatal intensive care unit included Desnoyers, a couple of staff nurses, a clinical nurse specialist, a project manager and an architect. An expert consultant was also invited to be part of the planning. “We also visited similar units at other [facilities] in Wisconsin, Minnesota and Iowa,” adds Desnoyers, noting it was helpful to learn what did or did not work at other hospitals.
Following the architect’s lead, the committee members discovered it would be feasible to build out and gain an additional 3,000 square feet of space for offices, supplies and storage areas. This decision added about $1 million to the project, bringing the total cost of construction to $6.5 million. The hospital foundation raised $2 million through fundraising, and Meriter funded the rest.
Construction began in February 2006 and concluded in March 2007. The staff and patients moved in two months later. The new monitoring equipment, wireless computer and wireless voice communication systems were great, according to Desnoyers, but the new environment provided much more in addition to state-of-the-art technology. The space catered to the needs of the newborns.
Of the 23 single-family rooms in the unit, seven are doubles to accommodate twins. Four of the doubles have sliding doors, opening up to an adjacent room when triplets are born.
Each room is about 180 square feet (doubles are about 360 square feet) and equipped with a couch that pulls out to a bed, a comfortable chair, storage space for the family, privacy curtains and a phone (which doesn’t ring, but lights up, cutting back on the noise level). In accordance with Wisconsin state building codes, each patient room has a window.
From floor to ceiling, special design features are incorporated to create a more pleasant experience for the baby and its family. Instead of vinyl flooring, for example, the architect selected rubber, which is more sound-absorbent. (Carpeting is even more sound-absorbent, but it needs to be replaced frequently and vacuuming can be noisy.) Even the ceiling tiles are designed for noise reduction, and the walls separating individual rooms are padded with extra-thick layers of insulation, also designed to block noise.
The windows have triple panes and built-in blinds, enabling staff and family to let in more or less light, depending on each baby’s needs, continues Desnoyers. The rooms are equipped with other flexible lighting options as well, she adds.
Desnoyers and her nursing staff will use a number of performance measures to help gauge the efficacy of the new unit. “We measured [these parameters] before we moved in, and we’ll do so again, six months after our [move-in date],” she says. Performance measures include:
- Nosocomial infection rates
- Noise levels
- Light levels
- Family satisfaction ratings (based on surveys)
- Staff satisfaction ratings (based on surveys)
- Medical and medication errors, such as mixing up breast milk or feeding solutions (Now, each baby’s room is equipped with a private refrigerator)
- Length of stay.
“We’ve already seen changes [in the babies],” says Desnoyers. “In a large ward or nursery, babies can be affected by other babies’ alarms going off.” So, if one baby monitor alarm is set off by an abnormal heart or breathing rate or abnormal oxygen saturation level, the noise can affect another baby and his alarm, and so forth. “It was a snowball effect,” she explains.
Today, there are no more snowball effects. In fact, the closest that babies in Meriter’s neonatal intensive care unit get to one another is at the nurses’ central monitoring station — and then, only in a virtual sense. The babies wear cardio-respiratory monitors, and central monitors at the nurses’ station enable the staff to keep a close eye on all patients at once. It is yet another perk that contributes to an environment that is “very, very nice for the patient, family and staff,” says Desnoyers.