Intensive care units (ICUs) are places of critical importance in the healthcare system, dedicated to the care of patients facing life-threatening conditions. However, the traditional ICU environment, characterised by constant light exposure, high levels of noise, and other stressors, can have adverse effects on both patients and healthcare professionals. Recognising these challenges, Chelsea and Westminster Hospital has undertaken an innovative approach to transform its ICU facilities, focusing on patient-centred care, technological innovation and partnership.
Recognising the ICU environment challenges
Intensive care units (ICUs) house patients who are often in critical condition, with complex medical needs. The ICU environment is an emotional place for healthcare professionals, who encounter challenging situations daily. They are also highly stressful environments for patients.
The impact of the ICU environment – which house numerous medical equipment, from ventilators, to monitors, infusion pumps, and dialysis machines – on patients has been widely acknowledged. High noise levels, in particular – often attributed to medical equipment, alarms, and staff activity – present a significant concern and have been shown to disrupt sleep patterns and negatively affect patient recovery.
Research underscores that, from the patients' perspective, noise is frequently the primary contributor to poor sleep quality in ICUs, which is often associated with difficulties in rehabilitation, impaired immune function, a higher incidence of delirium, and longer lasting neurocognitive changes.
Lighting is another significant factor and plays a crucial role in a patient's circadian rhythm, mood, and overall well-being. The lack of natural light exposure and irregular lighting patterns can lead to disorientation, further exacerbating the challenges patients face during their ICU stay.
Consequently, the ICU environment emerges as a critical factor in patient outcome and recovery, alongside its role in mitigating fatigue and enhancing staff performance, thereby contributing to better patient care.
Increasingly, innovative approaches aimed at improving patient, family and healthcare experiences have been the focus of research in the ICU. Today technology and innovation are at the forefront of transforming the way patients are cared after in these demanding environments.
Embracing innovation and collaboration for transformation
Situated in London, and with a rich history of innovation at its core, Chelsea and Westminster Hospital and its charity CW+ recently embarked on an innovative project to expand and redevelop the Hospital’s adult and neonatal critical care units. The Trust is a regional centre for neonatal care—it already runs one of the largest neonatal services in the country.
The transformation has been one of the largest and most complex projects undertaken in the hospital’s history. It sought to embed best practice and insights from other hospitals across Europe to create a more patient-centred and efficient ICU environment, incorporating the latest innovations and digital solutions to help significantly improve critically ill patients’ recovery and wellbeing.
The development of the new ICU builds on the hospital’s’ extensive research and practical experience of how physical surroundings have a direct impact on patient recovery – with the acoustics, lighting, layout and furnishing having all been selected for the patient’s brain, body and senses to rest and heal more effectively. Importantly, these innovations have been led by the staff who work within these challenging environments.
The redevelopment of the adult ICU and the neonatal intensive care units (NICU) includes environmental improvements such as new facilities and technological enhancements, and new respite spaces including an indoor botanical Sky Garden. The patient-focused environment also includes media screens to enable engagement with the hospital’s arts in health programme and contact with family and friends, noise-reducing equipment, and the latest sensor technology to monitor patients’ health, progress and environment.
These new facilities bring together the hospital’s core strengths in digital innovation, environment and design, and testing and scaling the latest clinical technologies.
Patient-focused critical care
The project, which has taken nearly two years to complete, has delivered some of the best, patient-focused critical care facilities in the country in a state-of-the-art environment. The capacity of the new Adult Intensive Care Unit (ICU) has increased by 45%, allowing the Trust to care for an additional 500 patients every year - the first phase was fast-tracked to open in March 2020 to help provide treatment for an increased number of patients in ICU due to the COVID-19 outbreak. The Neonatal Intensive Care Unit's (NICU) capacity has expanded by 40% providing specialist care to 150 more babies every year, as well as providing better clinical space and family facilities.
CW+, the official charity of Chelsea and Westminster Hospital NHS Foundation Trust, recently published an evaluation of the redevelopment of the adult intensive care unit at Chelsea and Westminster Hospital, two years after its official opening.
The report reveals that for patients, environmental improvements were found in reduced sound levels, warmer temperatures and a huge increase in daytime light levels. Extensive floor-to-ceiling windows have made the new ICU more than eight times brighter than in the old unit, contributing to a healthy circadian rhythm and potentially reducing the risk of delirium.
Staff also benefited from environmental improvements, including a significant reduction in the level of background sound. New respite and training spaces for staff were highlighted as having had a positive impact on staff experience, as was the Sky Garden, which was used for breaks, meetings and rest. The increased space within the unit was perhaps the most significant improvement for staff, facilitating the movement of patients and equipment, and, in combination with the overall aesthetic of the unit and window views, creating a calmer working environment.
Sharing the blueprint for transformative care
In the challenging landscape of intensive care, Chelsea and Westminster Hospital has embraced innovation and collaboration as cornerstones of its approach. By learning from other world-leading hospitals, incorporating innovations and digital solutions that can be personalised to each patient, the hospital has seen reductions in anxiety, pain and stress. The hospital now hopes to build a compelling evidence base and blueprint to share with sister institutions and across the NHS.
Elaine Manderson, Deputy Divisional Nursing Director for Planned Care and Critical Care Lead, Chelsea and Westminster Hospital NHS Foundation Trust says: “The benefits of what we’ve learned from how we’ve designed a critical care unit would be of massive benefit to other hospitals. When we were building the intensive care unit, we looked to overseas to see what was best practice and hopefully learned from our overseas colleagues. And similarly, now that we’ve actually built this amazing environment for our patients, we hope to be able to share that with other countries and other organisations.”
In this short video, Elaine explains how innovation and partnership has been at the forefront of the hospital’s approach to transforming the way intensive care is delivered to the benefit of patients and healthcare professionals. Watch it here.