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The business case for building better neonatal intensive care units

Journal of Perinatology volume 34, pages 811–815 (2014)Cite this article

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There is increasing evidence that the physical environment of the neonatal intensive care unit (NICU) has a tangible effect on the vulnerable infants who spend the first crucial weeks or months of their life there. While many aspects of NICU design have been evaluated, none is more tangible than the single-family room (SFR) concept because of its many potential benefits, possible hazards and its increased cost of construction. Data are now available to allow us to establish a cost-benefit analysis of SFR design in the NICU by assessing its impact on operating costs. This paper reviews the cost implications of SFR design and compares those with its quantifiable benefits. We also enumerate non-quantifiable benefits and hazards of SFR design and describe additional desirable, evidence-based design aspects for those who are considering new NICU construction or major renovation.

The design and construction of NICUs have some specialized attributes. NICUs have a unique and impactful microclimate and culture. As has been stated, ‘A case can be made that in no other part of the hospital is providing an optimal physical environment more important than the NICU because nowhere else will the adverse effects of noxious physical elements have more profound and long-lasting effects.’1 Studies conducted in NICUs now show clear correlations between incorporating evidence-based design (especially SFRs) and improved outcomes and lower operating costs. SFR require additional space that entails higher one-time construction costs and slightly increased heating, cooling and nonclinical support personnel costs. Therefore, it is important to ascertain whether the benefits of SFR design can justify these costs.

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References

  1. White R . Small comforts: evidence-based design comes to the NICU. HERD 2012; 5: 3.

    Article  Google Scholar 

  2. Berry LL, Parker D, Coile RC, Hamilton DK, O Neill DD,, Sadler BL . The business case for better buildings. Front Health Serv Manage 2004; 21: 3–24.

    Article  Google Scholar 

  3. Sadler BL, Berry LL, Guenther R, Hamilton K, Hessler FA, Merritt C et al. Fable hospital 2.0: The business case for building better health care facilities. Hastings Center Report 41 (no.1) 2011; 13–23.

    Article  Google Scholar 

  4. White RD, Smith JA,, Shepley MM . The Committee to Establish Recommended Standards for Newborn ICU Design. Recommended standards for newborn ICU design, eighth edition. J Perinatol 2013; 33: S2–16.

    Article  Google Scholar 

  5. RS Means. 2014 RSMeans Building Construction Cost Data, 72nd Annual Edition 2013; 861–871.

  6. Domanico R, Davis DK, Coleman F,, Davis BO . Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. J Perinatol 2011; 31: 281–288.

    Article  CAS  Google Scholar 

  7. Örtenstrand A, Westrup B, Broström EB, Sarman I, Åkerström S,, Brune T et al. The Stockholm neonatal family centered care study: effects on length of stay and infant morbidity. Pediatrics 2010; 125: e278–e285.

    Article  Google Scholar 

  8. Stevens DC, Helseth CC, Thompson PA, Pottala JV, Khan MA, Munson DP . A comprehensive comparison of open-bay and single-family-room neonatal intensive care units at Sanford Children’s Hospital. HERD 2012; 5: 23–40.

    Article  Google Scholar 

  9. NACHRI & the Center for Health Care Design. Evidence for Innovation: Transforming Children’s Healthcare through the Physical Environment. National Association of Children’s Hospitals and Related Institutions: Alexandria, VA, 2008.

  10. Shepley M . Design for Pediatric and Neonatal Critical Care. Routledge: London, 2014.

    Google Scholar 

  11. Hendrich AL, Fay J,, Sorrells AK . Effects of acuity-adaptable rooms on flow of patients and delivery of care. Am J Crit Care 2004; 13: 35–45.

    PubMed  Google Scholar 

  12. Brown KK, Gallant D . Impacting patient outcomes through design: acuity adaptable care/universal room design. Crit Care Nurs Q 2006; 29: 326–341.

    Article  Google Scholar 

  13. Harris DD, Shepley MM, White RD, Kolberg KJS,, Harrell JW . The impact of single family room design on patients and caregivers: executive summary. J Perinatol 2006; 26: S38–S48.

    Article  Google Scholar 

  14. Marshall-Baker A . Human and environmental health: sustainable design for the NICU. J Perinatol 2006; 26: S31–S33.

    Article  Google Scholar 

  15. Alimoglu MK, Donmez L . Daylight exposure and the other predictors of burnout among nurses in a university hospital. Int J Nurs Stud 2005; 42: 549–555.

    Article  Google Scholar 

  16. Figueiro MG, White RD . Health consequences of shift work and implications for structural design. J Perinatol 2013; 33 (Suppl 1): S17–S23.

    Article  Google Scholar 

  17. Hamel M, Zoutman D, O'Callaghan C . Exposure to hospital roommates as a risk factor for health care–associated infection. Am J Infect Control 2010; 38: 173–181.

    Article  Google Scholar 

  18. Walsh WF, McCullough KL, White RD . Room for improvement: nurses' perceptions of providing care in a single room newborn intensive care setting. Adv Neonatal Care 2006; 6: 261–270.

    Article  Google Scholar 

  19. Van Enk RA,, Steinberg F . Comparison of private room with multiple-bed ward neonatal intensive care unit. HERD 2010; 5: 52–63.

    Article  Google Scholar 

  20. Berwick DM, Nolan TW,, Whittington J . The triple aim: care, health, and cost. Health Affairs 2008; 27: 759–769.

    Article  Google Scholar 

  21. Erdeve O, Arsan S, Yigit S, Armangil D, Atasay B,, Korkmaz A . The impact of individual room on rehospitalization and health service utilization in preterms after discharge. Acta Paediatr 2008; 97: 1351–1357.

    Article  CAS  Google Scholar 

  22. Carter BS, Carter A,, Bennett S . Families' views upon experiencing change in the neonatal intensive care unit environment: from the ‘baby barn’ to the private room. J Perinatol 2008; 28: 827–829.

    Article  CAS  Google Scholar 

  23. Kotzer AM, Zacharakis SK, Raynolds M,, Buenning F . Evaluation of the built environment: staff and family satisfaction pre-and post-occupancy of the children's hospital. HERD 2011; 4: 60–78.

    Article  Google Scholar 

  24. Shepley MM, Harris DD, White R . Multiple-bed room and single-family room neonatal intensive care units: caregiver satisfaction and stress. Environ Behav 2008; 40: 249–268.

    Article  Google Scholar 

  25. Pineda RG, Stransky KE, Rogers C, Duncan MH, Smith GC, Neil J et al. The single-patient room in the NICU: maternal and family effects. J Perinatol 2011; 32: 545–551.

    Article  Google Scholar 

  26. Smith TJ, Schoenbeck K,, Clayton S . Staff perceptions of work quality of a neonatal intensive care unit before and after transition from an open bay to a private room design. Work 2009; 33: 211–227.

    Google Scholar 

  27. Milford CA, Zapalo BJ,, Davis G . Transition to an individual-room NICU design: process and outcome measures. Neonatal Netw 2008; 27: 299–305.

    Article  Google Scholar 

  28. Stevens DC, Helseth CC, Khan MA, Munson DP,, Smith TJ . Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design. J Perinatol 2010; 30: 352–358.

    Article  CAS  Google Scholar 

  29. Pineda RG, Neil J, Dierker D, Smyser CD, Wallendorf M,, Kidokoro H et al. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr 2014; 164: 52–60.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Design Environmental Analysis, Cornell University, Ithaca, NY, USA

    M M Shepley

  2. Smith Hager Bajo Inc., Ashburn, VA, USA

    J A Smith

  3. Institute for Healthcare Improvement, La Jolla, CA, USA

    B L Sadler

  4. Pediatrix Medical Group, Memorial Hospital, South Bend, IN, USA

    R D White

Authors
  1. M M Shepley
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  2. J A Smith
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  3. B L Sadler
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  4. R D White
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Correspondence to R D White.

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Shepley, M., Smith, J., Sadler, B. et al. The business case for building better neonatal intensive care units. J Perinatol 34, 811–815 (2014). https://doi.org/10.1038/jp.2014.174

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