Colorado-Real-Estate-Journal_432803

38 / BUILDING DIALOGUE / DECEMBER 2024 ELEMENTS Health Design Using Patient-Centered Design to Reduce ICU Delirium I ntensive care unit delir- ium has gone by many names throughout the years, varying by location and medical specialty: ICU psychosis, ICU syndrome, acute brain disfunction, septic encephalopathy, to name a few. A severe and debilitating condition char- acterized by acute states of confusion, ICU delirium is a significant com- plication that affects up to 80% of all critical care patients. This condition can be associated with longer hospital stays, increased health care costs, and further physical, cognitive and psychological impairments, which may require treatment and management even after dis- charge. How can design impact ICU delirium, here in Colorado and around the nation? Below, we’ll take a brief dive into its causes and risk factors, the interrelationship between environmen- tal design and health, and the impact of a pa- tient-centered design. n Causes and risk factors of ICU delirium. For anyone who has experienced delirium or witnessed a loved one in a state of delirium – a disturbed state of mind resulting in confused thinking and reduced awareness of one’s sur- roundings – it can be a scary, unsettling, often traumatic experience. Usually temporary and developing over a short period of time, a state of delirium can include fluctuations in memory, language and perception. It is derived from the Latin “de lira,” meaning “out of the furrow” or “off the track.” ICU delirium, as the term suggests, is a state of cognitive and conscious decline that has been found to occur specifically within critical care environments. While community incidents of delirium range from 1%-2%, studies have shown that risk increases with severity of illness or medical conditions, finding inci- dence of delirium in medical-surgical units between 14% and 24%, post-operative care between 15% and 53%, and in- tensive care units exceeding 40%, with some studies estimat- ing up to 83% of patients on mechanical ventilation experi- ence some degree of delirium. ICU delirium impacts patients across the spectrum – from lower-acuity medical-surgical patients to high-acuity cardi- ac, traumatic brain injury and shock patients. Experts have postulated that the exposure to multiple physical, mental, and environmental risk factors concurrently ultimately leads to ICU delirium. While some factors cannot be prevent- ed, such as age and severity of disease or injury, researchers and designers have begun to focus on which environmen- tal factors can be addressed. These factors include excessive noise, disruption to sleep and circadian rhythm, suboptimal lighting, lack of natural views, isolation, lack of cognitive stimulation, immobility and inability to personalize space. n Key design strategies to prevent ICU delirium. Rath- er than focusing on the treatment and management of delir- ium after it happens, what if the relationship between envi- ronment and health is studied to prevent the environmental Calise Gritters, AIA, EDAC, LEED GA Healthcare Planner, Page Caleb Tkach UCHealth University of Colorado Hospital Anschutz Inpatient Pavilion 3, Inten- sive Care Unit, Aurora. Evidence-based design elements include use of noninsti- tutional, natural-looking materials and finishes, artwork to illustrate nature, and access to daylight and views.