Guideline on Adult ICU Design 2024

Diana C. Anderson, MD, M.Arch, FACHA D. Kirk Hamilton, PhD, MSOD, BArch, Emeritus FAIA & FACHA, FCCM Jodie C. Gary, PhD, RN

PUBLISHED: 02/20/2025

Guideline on Adult ICU Design 2024

Citation: Hamilton DK, Gary JC, Scruth E, et al. Society of Critical Care Medicine 2024 guideline on adult ICU design. Crit Care Med. In press.

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Advances in technology, infection control challenges—as with the COVID-19 pandemic—and evolution in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement. These guidelines provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

The guidelines panel issued 17 recommendations based on 15 Population, Intervention, Comparison, and Outcome (PICO) questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, with windows and natural lighting in 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 regarding in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

Guideline Type: Administrative

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We recommend designing ICUs to have high patient visibility.
Quality of evidence: Low

ICU layout Strong Patient visibility

Either decentralized or centralized ICUs staff charting areas may be used.

ICU layout Charting areas

We suggest ICUs use single-patient rooms rather than open-bay layouts.
Quality of evidence: Very low

ICU layout Conditional Patient rooms

New facilities should locate critical care units as close as possible to frequently used non-ICU care sites (e.g., surgery, recovery, emergency, imaging, procedural areas) to reduce transport and adverse patient events.

ICU layout Good practice statement ICU location

We recommend having windows and natural lighting in all ICU patient rooms.
Quality of evidence: Low

Room design Strong Lighting

We suggest using noise-reduction strategies (e.g., sound-absorbing tiles) to reduce ambient noise.
Quality of evidence: Very low

Room design Conditional Noise reduction

Either in-room or centralized supply room location(s) may be used.

Room design Supply room

Either advanced HVAC systems or standard HVAC systems can be used, depending on the resources available and feasibility of implementation at a given site.

Infection control Ventilation

ICUs should incorporate advanced infection prevention features to prevent airborne, waterborne, and surface-borne transmission.

Infection control Good practice statement Infection prevention

We suggest designing ICUs with capacity for monitoring and controlling devices outside of patient rooms.
Quality of evidence: Very low

Infrastructure Conditional Monitoring devices

We suggest building ICUs using tele-ICU capacity.
Quality of evidence: Very low

Infrastructure Conditional Tele-ICU

ICU designs should plan for surges in patient volumes, and this should consider the ICU space, as well as novel hospital spaces.

Infrastructure Good practice statement Patient volume

We suggest nonwall-based life support utility access (e.g., power columns, pendant-mounted booms).
Quality of evidence: Very low

Infrastructure Conditional Life support utilities

We suggest using ergonomic designs in the ICU both for staff workspaces and patient care areas.
Quality of evidence: Very low

Staff space Conditional Ergonomic design

ICUs should include dedicated staff break rooms.

Staff space Good practice statement Staff break rooms

We suggest separate quiet rooms and respite spaces to promote staff wellbeing.
Quality of evidence: Low

Staff space Conditional Quiet rooms

ICU designs should permit use of mobile workstations or devices.

Staff space Good practice statement Mobile workstations

Author

Diana C. Anderson, MD, M.Arch, FACHA

Diana C. Anderson, MD, M.Arch, FACHA, is a triple-boarded professional. She is a healthcare architect (American College of Healthcare Architects), an internist, and a geriatrician (American Board of Internal Medicine). As a “dochitect,” she pioneered a collaborative, evidence-based model for approaching healthcare from the medicine and architecture fields simultaneously. She has worked on hospital design projects globally and is a frequent speaker about the impacts of healthcare design on patient outcomes and care delivery. She is a cofounder of Clinicians for Design, an international network of leaders that seeks to inspire and accelerate the design of environments and systems. A past fellow of the Harvard Medical School Center for Bioethics, she explores the ethics of built space. Her publications include numerous peer-reviewed articles, medical textbook chapters, podcasts, and news and media contributions (e.g., New York Times, Metropolis, Bloomberg Press). She is currently an assistant professor of neurology at Boston University and a recipient of an Alzheimer's Association Clinician Scientist Fellowship.

Author

D. Kirk Hamilton, PhD, MSOD, BArch, Emeritus FAIA & FACHA, FCCM

D. Kirk Hamilton, PhD, MSOD, BArch, Emeritus FAIA & FACHA, FCCM, is the Julie & Craig Beale Endowed Professor of Health Facility Design at Texas A&M University, where he has taught healthcare design at the graduate level since 2004. His academic research is on the relationship of evidence-based health facility design to measurable organizational performance. His bachelor of architecture degree is from the University of Texas in Austin. His master’s degree in organization development is from Pepperdine University, and his PhD in nursing and healthcare innovation is from Arizona State University, where he studied nurse movement patterns and interaction with objects in the ICU patient room.

A fellow of the American Institute of Architects, he is board certified by the American College of Healthcare Architects with 30 years of active practice prior to joining Texas A&M. He is only the second architect advanced to fellowship in the American College of Critical Care Medicine. He is a founding principal emeritus of Houston’s WHR Architects (now EYP Health) with healthcare projects in 20 states and eight other countries. He has received the Lifetime Achievement Award from the American College of Healthcare Architects and the Changemaker Award from the Center for Health Design.

A frequent author and presenter, he is a founding coeditor of the peer-reviewed, interdisciplinary Health Environments Research & Design journal, now in its 12th year.

Author

Jodie C. Gary, PhD, RN

Jodie C. Gary, PhD, RN, is an assistant professor in the College of Nursing at Texas A&M University Health Science Center. She teaches across the curriculum from baccalaureate students to master level in research and adult health concepts. Prior to entering academia, she earned 20 years of healthcare experience including field emergency medical management, clinical and laboratory research, and primary care nursing, including supervisory positions in telemetry and critical care. Her primary research focus is the delivery of patient-centered care within the complexity of healthcare.