Scientific studies conducted by renowned research groups show how innovative approaches to the design of intensive care units (ICUs) can improve patient care in the long term. The studies presented here highlight key topics in the field of patient-centered care:
A study by the University of Wuppertal examines the role of light and color in intensive care environments. The results show that targeted adjustments in lighting design and the use of soothing colors can have a positive impact on both patient well-being and the working environment of medical staff. These findings provide valuable insights for creating patient-centered and functional ICU designs.
These studies underscore the importance of an evidence-based approach to the further development of intensive care medicine and offer valuable insights for physicians, hospital administrators, and planners.
Alawi Luetz, Helmut Piazena, Björn Weiss, Annette Finke, Thomas Willemeit and Claudia Spies
„BACKGROUND Sleep abnormalities and disturbances of the circadian rhythm are known to negatively affect recovery for pa-tients in the Intensive Care Unit (ICU). Daylight is the most important stimulus to entrain circadian rhythmicity by suppres-sion of melatonin production. Therefore, light therapy seems a promising intervention to improve patients’ outcome. This study examined photometric parameters of different electric light sources in the ICU.
METHODS Light measurements were conducted in the ICU of a tertiary care medical centre in Germany (NCT02143661). We assessed spectral irradiance, illuminance, luminance, correlated colour temperature and colour rendering index of a fluores-cent tube lamp (FL1), a fluorescent lamp with micro-lens optic (FL2) and a newly developed LED light-ceiling. Measurements were determined at patients’ eye level. Spectral irradiance was assessed with a double monochromator spectroradiometer. Circadian effective irradiance was calculated by weighting the spectral irradiance with the action spectrum for melatonin suppression and by integration over all effective wavelengths.
RESULTS The new LED light-ceiling revealed higher illuminance levels than FL1 and FL2 (1,900 to 2,750 lux vs. 260 to 750 lux and 500 to 1,400 lux). The colour rendering index was higher for the LED ceiling than both fluorescent lamps (97% vs. 74% and 77%). FL2 exceeded the threshold level of absolute glare (>10,000 candelas). The circadian effective irradiance was high for the LED ceiling compared to FL1 and FL2 (1.98 - 2.89 W/m2 vs. 0.29 - 0.5 W/m2 and 0.41 - 1.16 W/m2)
CONCLUSION Only the newly developed LED light-ceiling provided sufficient circadian effective irradiance for maximal mela-tonin suppression without entering the area of absolute glare. These results should be considered when designing future health-promoting environments for critically ill patients.“
Source:
Luetz A, Piazena H, Weiss B, et al.: Patient-centered lighting environments to improve health care in the intensive care unit. Clin Health Promotion 2016; 6:5–12.
Alawi Luetz, Julius J. Grunow, Rudolf Mörgeli, Max Rosenthal, Steffen Weber-Carstens, Bjoern Weiss, Claudia Spies
„Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in “Post-ICU Syndrome” (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep–wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects. The main areas affected by most architectural and interior design modifications are sound environment, light control, floor planning, and room arrangement. Implementation of corresponding solutions is challenging considering the significant medical and technical demands of ICUs. This article discusses innovative concepts and promising approaches in ICU design that may be used to prevent stress and to support the healing process of patients, potentially limiting the impact of delirium and PICS.“
Source:
Luetz A, Grunow J, Mörgeli R, et al.: Innovative ICU solutions to prevent and reduce delirium and post-intensive care unit syndrome. Semin Respir Crit Care Med 2019; 40:673–686. Click here to get the whole study
Spies, Claudia MD; Piazena, Helmut PhD; Deja, Maria MD; Wernecke, Klaus-Dieter PhD; Willemeit, Thomas BA; Luetz, Alawi MD; ICU Design Working Group
„OBJECTIVES Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study’s primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed.
DESIGN Prospective observational cohort pilot study.
SETTING The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system.
PATIENTS Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms.
INTERVENTIONS None.
MEASUREMENTS AND MAIN RESULTS The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent (n = 28) of patients in the standard rooms developed delirium compared with 46% of patients (n = 17) in the modified rooms (p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582–3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin (p < 0.0001). Significant interactions (p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time.
CONCLUSIONS Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.“
Source:
Spies C, Piazena, H, Deja M, Wernecke K, Willemeit T, Luetz A. Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study. Critical Care Medicine 52(4):p e182-e192, April 2024. Click here to get the whole study
Prof Dr Axel Buether, Dr Gabriele Wöbker
„Summary of the results: The effects of colour and lighting design, which have been observed in the scope of qualitative and quantitative research, are significant in terms of patients as well as staff. The survey of the patients as well as the interviews of the staff prior to and after the implemented measures of renovation provide evidence for the efficacy of the psychological environmental factors colour and light on the well-being and the satisfaction of the human.
The perception of the factors of design increased concerning the patients about averagely 32,3%, concerning the staff even about 40,8%. The highest increase occurred at the patients besides the evaluation of the colour design (62,7%) at the sensation of privacy, which improved by 55,2%. At the staff, the highest increase was recorded likewise at the colour design of 75,6%, followed by the perceptible improvement of the quality of artificial lighting by 54,3%. This factor is all the more exceptional as the new illuminants were disregarded for financial reasons. The available neon illuminants were replaced by LED illuminants with an index of colour reproduction of 90, whereby the colour of the rooms seemed relatively natural. The colour temperature of the light was kept warm white (3.000 K) in the rooms of the patients and the staffrooms. On the corridors and the functional rooms, however, cold white resp. daylight white was used (4.000 K).
The contrast generates a ‘shift of the atmosphere’, through which the staffrooms appear perceptibly cosier, warmer, and securer. Moreover, perceptions such as slow movement and calmness were described.
The effects of the factors of the room colour and light not only extent to the perception of the architectural room, but also to the welfare. The ‘wellness-atmosphere’ room impression of the staffrooms and patient rooms, titled by people concerned, provides a more effective care. The evaluation of the measures of care increased at the patients after the renovation by 28%. These indirect effects were also observed at the staff, whereby the satisfaction of work on average increased by 12%.
The consumption of medication could be reduced distinctly. At the benzodiazepines, no significant changes were observed. At the acute-neuroleptics (haloperidol, risperidone, chlorprothixene etc.), perspicuous changes occurred. In the reference period, the consumption decreased by averagely 30,1%.“
Prof Dr Axel Buether, Dr Gabriele Wöbker; Assessment of the psychological and medical effects of the environmental factors colour and light on patients and staff in the department of intensive-care medicine; Click here to get the whole study
