ICU overhaul ahead? Here’s where to start

Hospital leaders contemplating a rebuild of the intensive care unit should consider it mandatory to bring critical-care nurses into discussions about unit layout and room design right from the start.

They would also do well to make sure ample time is dedicated to talking through infection control, physical infrastructure and staff spaces.

Finally, the ICU design steering committee—or whatever name it takes for itself—ought to emphasize such features as patient visibility, single-patient rooms, natural lighting, and advanced heating, ventilating and cooling systems.

The recommendations are from a peer-reviewed article published in the journal Critical Care Nursing Clinics. 

The paper, authored by Texas A&M professors Jodie Gary, PhD, RN, D. Kirk Hamilton, PhD, and colleagues, updates and analyzes guidance issued by the Society of Critical Care Medicine in 2024. 

Gary and co-authors note that the 2024 work, published by Critical Care Medicine in 2025, represents the first ICU design guidelines to be “fully evidence-based” and “developed through systematic literature review and meta-analysis.”

In-depth research translates to fairly simple steps  

In this year’s update, Gary and co-researchers detail the evidence-based reasoning and practical considerations behind each point of advice. 

They also offer a set of 10 quick pointers to summarize the major imperatives that have emerged from the work to date. Here are five examples:  

• Plan for surge capacity. Design flexible spaces that can accommodate additional patients and support services during emergencies or pandemics.
   
• Support decentralized charting. Consider decentralized documentation stations to reduce walking distances and improve efficiency.
   
• Design for future adaptability. Create ICU environments that can evolve with technological advances and changing clinical needs.
   
• Incorporate noise reduction strategies. Use sound-absorbing materials to reduce stress and cognitive overload in high-acuity environments.
   
• Engage nurses in design. Involve frontline nursing staff in ICU planning to improve workflow, safety and care delivery outcomes.

Plenteous professional perspectives 

In coverage by Texas A&M’s news division, Gary says the years-long undertaking came to fruition thanks to close stakeholders’ desire to “bring more structure to decisions that have traditionally relied on experience and institutional practice.”

“Before this work, ICU design was largely guided by expert opinion and practical experience,” she adds. “This guideline brings a systematic, evidence-based approach to how these spaces should be built and organized.”

Gary also says the multidisciplinary makeup of the panel leading the project strengthened the final recommendations by bringing together critical-care physicians with not only ICU nurses but also experienced architects and engineers. 

“When you bring these disciplines together,” Gary says, “you get a much clearer picture of how the environment affects care.” 

The new paper by Gary and Hamilton, et al., is here.