Adaptive Reuse: 
Transformation of a Hospital’s Vacant
Med-Surg Wing into a State-of-the-Art ICU  

by Kevin J. Morris, AIA, CSI, CDT, CCCA, LEED G.A.

If you are remotely involved in Healthcare industry or the Medical profession, you are certainly familiar with the “alphabet soup” of acronyms associated with the various healthcare services and departments. Medical abbreviations can be quite complicated and are frequently interspersed throughout the profession to identify a litany of items including; Hospital Types, Departments, Procedures, Diseases, Specialist, Personnel, Medications, Instruments, and Services – to name a few. 

The I-C-U, or Intensive Care Unit, is perhaps a more common acronym that, unfortunately, many individuals are probably very familiar with, particularly with recent conditions concerning COVID-19.  While not welcomed, we have all probably experienced a time in our lives when someone was in a critical stage of their health and required the most intense care and attention. Patient rooms in an ICU can be quite intimidating, simply by the intrusive presence of the equipment. In the past, ICU rooms were generally small in footprint, often overwhelmed by a network of equipment, tubes, connections, and monitors. Because patients are generally immobile, private restrooms were not typically provided in ICU room configurations. Furthermore, there was very little consideration or accommodations provided to address a family member’s personal needs. In these circumstances, a critical patient may often be in this condition for an extended time, making it difficult for the patient and their family members to endure this stressful time. These circumstances present challenges that must now be considered when addressing the ideal design requirements for a present-day ICU.

An intimidating visual.

Photograph by Ina Fassbender / AFP / Getty

Rising to the Challenge – the Critical Care Conversion

The Healthcare Team of Holly & Smith Architects recently completed a monumental conversion of an existing 13,000 square foot Patient Room wing into a new state-of-the-art ICU Department. The initial design challenge was that the original 1970’s era building contained what was commonly referred to as a “saw-toothed” building exterior.  This Patient Care Tower configuration, while typical of its time and era, allowed for clusters of four private patient rooms to be accessed from the main corridor while still allowing daylight to enter. This design layout was then stacked from floor to floor in a repetitive fashion, primarily for efficiency and economy.  Patient rooms were 120 square feet in area, providing minimal shower and toilet accommodations.

Plumbing and medical gases were “clustered” back-to-back for economy and routed through a forest of multi-floor vertical chases. Handwash sinks were only placed in the patient room for sanitary requirements and not duplicated in the patient bathroom. Based on the existing structural framing, there was limited opportunity to relocate the plumbing vertical stacks. Considering the requirements to accommodate the integration of an ICU Department, all of these obstacles and challenges would have to be addressed.

Critical Components to Consider

In providing a solution that overcame the physical barriers, additional items had to be taken into consideration.

• GOING BEYOND STANDARD: Considering the requirements for Universal Design and Accessibility, several rooms would be required to address handicapped and bariatric conditions.  Neither of these items were accommodated in the previous room arrangement.
• FAMILY-CENTERED ACCOMMODATIONS: Providing a family zone, as well as private restrooms and shower, increased the spatial demand on the area requirements.   Neither of these items was accommodated in the previous room configurations.
• AREA INCREASES: Based on the existing conditions and the area requirements prescribed by the Department of Health and Hospitals, the size of the new ICU room could only be achieved by combining the area of (2) existing patient rooms.  This would mean that the previous department of (32) rooms would yield a (16) ICU room configuration. While this was a decrease in quantity, it was an unmeasurable increase in quality of care. 

Overcoming the Challenges

With a litany of complexities hindering the freedom of design, the Design Team had to respond to the challenges and present a design solution that was innovative and effective. The design ideas included:

• Shifting the Bay: The modular bay unit was shifted from its current configuration and transformed from a four-patient room cluster into a two ICU room configuration with an immediately contiguous nurse's station.  

• Direct Access: Providing an even number of ICU rooms allowed for direct and perpetual visual observation from a centrally located nurse station point.  Telemetry and E-ICU were introduced for patient observation and care from the central nurse station or remote caregiver location.

• Separation of Spaces: The new patient room created clearly delineated zones for patients, medical staff, and family. The increased clearances around the patient bed accommodated a new headwall for all equipment. Bariatric accommodations were provided overhead to assist in patient caregiving and mobility. 

• Hospitality Accommodations:  Restrooms were increased to provide the availability to able-patients in recovery and accommodations for family members.

• Patient Access to Daylight:  The new room configuration allowed additional lighting to be introduced to the previous room arrangement. 

• Amber Lighting: Amber lighting was introduced to help promote the natural circadian rhythms and promote the body’s natural healing abilities.

• Additional Department Amenities:  Copper-infused linens and copper grab bars/fixtures were provided to minimize the spread of germs.

With these simple, yet effective ideas, the schedule was able to be compressed with the project completing construction within 6 months.  Overall, the benefits experienced by the health care institution included:

• Adaptive Re-use: Converting a previously under-used hospital floor to accommodate a growing demand for ICU Patient Rooms
• Sensible Design: Creative, yet economically responsive design solutions to minimize, if not eliminate, unnecessary project expenses
• Quality of Care: Providing new state-of-the-art accommodations that improve the overall environment, increase the quality of care, enhance the patient experience

Typical ICU patient room by Holly & Smith Architects

Bariatric ICU patient room by Holly & Smith Architects

H/S EXPERIENCE

As human beings, we spend our personal and professional time within the built environment. As Architects, we are privileged to create spaces where people can gather, live, learn, work, eat, sleep, and worship. Therefore, it is incumbent that we design spaces that enhance the quality of life and nurture a greater passion for living. Our design approach is influenced by the environment, culture, and community in which architecture exists. To take it further... We Design for Life.

Kevin J. Morris is a Principal at Holly & Smith Architects and has over 25 years of experience in facilitating complicated design projects throughout southeast Louisiana, particularly in the medical profession.  There is no project that is considered too complicated, or too challenging.  All projects are embraced with an opportunity to exemplify a creative design solution, given restrictions on time, resources and money.