Observational study of treatment space in individual neonatal cot spaces

Purpose: Technology developments in neonatal intensive care units have increased the spatial requirements for clinical activities. Because the effectiveness of healthcare delivery is determined in part by the design of the physical environment and the spatial organization of work, it is appropriate to apply an evidence-based approach to architectural design. This study aimed to provide empirical evidence of the spatial requirements for an individual cot or incubator space. Subjects and Methods: Observational data from 2 simulation exercises were combined with an expert review to produce a final recommendation. A validated 5-step protocol was used to collect data. Step 1 defined the clinical specialty and space. In step 2, data were collected with 28 staff members and 15 neonates to produce a simulation scenario representing the frequent and safety-critical activities. In step 3, 21 staff members participated in functional space experiments to determine the average spatial requirements. Step 4 incorporated additional data (eg, storage and circulation) to produce a spatial recommendation. Finally, the recommendation was reviewed in step 5 by a national expert clinical panel to consider alternative layouts and technology. Results and Conclusions: The average space requirement for an individual neonatal intensive care unit cot (incubator) space was 13.5 m (or 145.3 ft). The circulation and storage space requirements added in step 4 increased this to 18.46 m (or 198.7 ft). The expert panel reviewed the recommendation and agreed that the average individual cot space (13.5 m/[or 145.3 ft]) would accommodate variance in working practices. Care needs to be taken when extrapolating this recommendation to multiple cot areas to maintain the minimum spatial requirement.