An ICU should be a geographically distinct area within a hospital. It should function as an autonomous department with controlled access and no through traffic. Ideally, there should be separate access for visitors and staff, and provision should be made for escape from fire.
Ideally, the location of an ICU within a particular hospital will be determined by the case mix of patients to be admitted and the situation of other departments with which ICU staff will be in regular contact. For some hospitals there will be an ideal site. An ICU admitting burn patients from a wide area might best be situated on the ground floor near the ambulance entrance, whereas a cardiothoracic or neurosurgical ICU would be better adjacent to the operating theater suite with easy access to the radiology department. In many cases the location will be a compromise, but most general units will usually be in proximity (either horizontally or vertically) to the operating theater, the accident and emergency department, or the radiology department.
Transport of critically ill patients between units or between departments of the same hospital is known to be associated with risk, but proximity of the radiology department or operating theater to the ICU does not abolish that risk since the time taken to perform the investigation or surgical procedure is usually much longer than the transport time. Obviously time spent in elevators with the attendant risks of breakdown should be minimized, but it seems likely that the additional risks of transporting critically ill patients are more closely related to equipment deficiencies and staff inexperience than to distance between departments ( Manji and Bion... 1995). Monitoring and supervision of the patient should be no less intense because the patient is being moved; rather, they should be more intense.
There is no specific requirement that an ICU be on a particular level, although evacuation of the unit during a fire hazard would be more readily accomplished in a ground floor unit. Sharing of engineering services with other departments such as operating theaters might seem advantageous, but this is by no means an overriding factor and may indeed reduce flexibility. Patient routes should be separate from transport corridors, and any elevator access required should be under keyed control. Disruption is minimized by separate supply and service access via perimeter corridors, but such corridors will inevitably restrict access to natural light.
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