Intensive Care Units: Challenges, Realist Reviews, and Built Environment Impact

Introduction

An intensive care unit (ICU) is a specialized medical ward where patients receive advanced care for severe injuries or critical medical conditions. The need for ICUs has increased due to the rise in life-threatening conditions and improvements in diagnosing and treating them. Despite the advances, intensive care survivors often face long-term complications known as post-intensive care syndrome (PICS), which includes physical, cognitive, or psychiatric issues that affect daily living activities. This article discusses various aspects of intensive care, including the challenges faced by survivors, the role of realist reviews in improving outcomes, and the impact of the built environment on patient outcomes.

Challenges Faced by Survivors

While approximately 80% of critically ill patients treated in an ICU survive, the cost of survival can be significant. Up to 25% to 50% of survivors develop PICS, resulting in a constellation of new or worsening physical, cognitive, or psychiatric complications. Additionally, mortality rates remain high after ICU discharge.

Realist Review for Improving Outcomes

Realist reviews aim to develop and refine a theoretical understanding of the effectiveness and contexts of interventions designed to improve outcomes for ICU survivors. By examining the underlying mechanisms and processes, realist reviews can identify strategies to address PICS and enhance patient care. Transforming ICU care requires a holistic approach that considers factors like the care process, organizational culture, and patient-centered approaches.

Impact of Built Environment on Patient Outcomes

The built environment in ICUs has been subject to research, specifically focusing on factors like stress reduction, staff burnout, collaboration, systems outcomes, and design criteria. Some key considerations include reduced energy consumption, healthcare costs, infection control, prevention of adverse medical events, and patient-centered care. For example, the Synergy Model, which links patients' characteristics with nursing competencies, is a framework for understanding patient- and family-centered care in the intensive care unit. However, there is a need for an integrated framework that includes all ICU team members and interventions, as well as perspectives from both the medical teams and patients or their families.

Conclusion

Intensive care units play a crucial role in saving lives but also present challenges related to long-term complications and high mortality rates after discharge. Realist reviews can help identify strategies to improve post-ICU outcomes by examining contexts, mechanisms, and outcomes. Additionally, the built environment in ICUs can significantly impact patient outcomes, emphasizing the importance of considering aspects such as stress reduction, collaboration, and patient-centered care in facility planning, design, and management.