Designing the future Neonatal Intensive Care Unit

Among the school students taking part in the “Redesigning the Neonatal ICU” class were Maryam Attai, Suhui Chen, and Stephen Jacobson. They are pictured here with product designer Jules Sherman and Dr. William Rhine, instructors of the 12-week course.

Working as a neonatologist at Stanford University and Lucile Packard Children’s Hospital over the past 25 years, William Rhine, MD has seen first-hand the latest technological and medical advancements in caring for preterm babies.

“What we’ve been able to achieve in saving and caring for these most vulnerable of infants has really been astounding,” Rhine said. “Still, we need to always be mindful of the need for continuous improvement in quality and safety.”

That’s why Rhine, while on sabbatical in 2014, set out to devote more time exploring ways to improve the design components that can impact quality and safety in a neonatal intensive care unit (NICU) environment.

At the suggestion of his wife, Rhine contacted the Institute of Design at Stanford, commonly known as the d.school, and began working with Jules Sherman, a product designer and class instructor, to develop a course that would require students to create a product, system, or service that would improve a typical NICU environment.

The students who took the course, called Redesigning the Neonatal ICU, came from various education disciplines, including mechanical engineering, education, law, premed and business. During the twelve-week fall quarter course, the students learned about the NICU from speakers, literature, simulations and field trips to visit premature and other sick babies and their parents. Then, they developed prototypes and concepts that offered to improve or enhance the NICU setting.

“It was a remarkably diverse group and representative of the brain power that exists on the Stanford campus,” said Rhine, medical director of the hospital’s NICU. That unit is designated as a Level IV facility, meaning that it provides the highest level of care possible. “With the students’ different backgrounds and experience, they brought a fresh perspective and view of the world.”

During the final class in December, the students presented their projects to the instructors and an audience that included medical staff and even parents of preemies, who had provided feedback to the students. The projects included a web-based program and manual to keep parents informed of their baby’s condition and progress; a program on transitioning babies home; a wall-mounted screen to provide better privacy for parents; and a new chair design that better meets parents’ needs when at their baby’s bedside.

Another group of students examined ways to cut down on the noise level in the NICU by looking at novel ways of interacting with the many beeps and alarms that care teams encounter.

Maryam Attai, a doctoral student at Stanford Graduate School of Education, whose group surveyed parents about their concerns transitioning from the NICU to home, said the course provided students with opportunities to engage in deep empathy work with the NICU medical staff and parents.

“The students came up with really important ideas,” said Rhine, professor of pediatrics (Neonatal and Developmental Medicine) at the Stanford School of Medicine. “They were also able to identify needs that would improve care and experience for both parents and staff. This was especially valuable since the ideas were actually based on interviews parents and bedside caregivers,” Rhine added. “Though the projects will need additional work before being implemented, some of them certainly fit in with our current unit of operations and some could be considered for use in the future.”

Whether the students’ projects go on to become a reality is yet to be seen. However, going through the process of teaching the course, Rhine learned that reaching out to a larger audience for input is valuable to achieving an optimal design.

“Working with these students has given me hope and inspiration. They let me know that in just a short amount of time, it’s possible to develop innovative and workable ideas for a very complex environment,” Rhine said.

“In the meantime, we need to keep asking these types of questions of staff, and families,” said Rhine. “How can we continuously do better at treating critically ill newborns, while engaging and supporting their parents? The students have given us some important new insights, and we believe their concepts could play a role in the future of NICU design.”

More details on the students’ “Redesigning the Neonatal ICU” presentations and projects are at http://www.redesignhealthcare.org/2014/12/10/final-presentation-day/.