Karolinska Institutet was founded in 1810 and is one of Sweden’s oldest medical universities. The organization has been studying NICU medical practice, planning, and design since about the time neonatal medicine officially came into existence in the 1960s.

Located in Solna, just on the edge of Stockholm, the Institutet was the final stop on my research tour of NICU design, as part of the Spencer de Mille Traveling Fellowship through the International Interior Design Association (IIDA) Northern Pacific Chapter Knowledge Advancement Fund.

Currently, the Institutet is working on putting its newest research into practice in a new hospital, Karolinska Solna University Hospital (NKS), which is expected to open in 2016.

True to Swedish culture, the Institutet prides itself in being open and generous with its information. When I arrived I was given a program for my visit, which included visiting two existing Karolinska University Hospitals (Huddinge and Danderyd, in the suburbs of Stockholm) and touring the Solna project in construction.

Each hospital invited me into their morning meetings, introduced me to people from every part of the NICU, and allowed me to sit with nurses and watch them work.

NICU design in Sweden has developed largely as a result of the application of research and adjusting according to ongoing practice and additional research. Facilities all over the Stockholm area share information and staff so that neonatal care can be administered effectively and in geographically appropriate locations for each family. This also seems to allow for more openness in information sharing and more consistency in process.

In the case of Karolinska Institutet hospitals, staff typically have a home base but can be temporarily moved to other locations if the demand is there. And since all NICUs have the same care processes, labeling systems, and staffing structure, a nurse can easily adjust to the new location.

For example, the Huddinge and Danderyd facilities use a day calendar that employs a color-coding system based on the level of acuteness of the baby. This system is incredibly straightforward, using colored dots on a calendar to denote L1, L2, and L3.

To improve processes on the design side, Peter Frost, a Swedish architect who has worked with the organization on its Huddinge hospital, developed an effective system as part of his Ph.D. studies. Staff and patients from each facility participate in innovative medical planning processes that involve nurses from each ward along with other staff and patients.

In a series of charrettes, staff and patients look at the footprint of the building and talk through how they use space and what their needs are. Although this process is now familiar to healthcare designers in the U.S., it was developed in Sweden for NICUs and has spearheaded great strides in healthcare since it’s been implemented.

Also, it seems the true essence of this process is much more collaborative and long-term then the adapted process I have seen in the U.S. For example, active NICU staff in Sweden are involved from concept to the punch list of a project in a consultant role. Additionally, patients and NICU staff provide feedback on the facility throughout its lifespan and some participate in research on the campus to further NICU design.

All of this creates an environment where designers can co-design and innovate with first-hand knowledge. The NICU at the Huddinge hospital used this method of planning to locate single-family patient rooms directly adjacent to the intensive care unit (ICU), allowing for more efficient care.

Other thoughtful additions, such as a special room for families to mourn if a baby dies, have also been well received by the patients. The facility has seen incredible results: The median stay for patients is 10 days less with the single family patient rooms.

Information like this was used during the planning for the new hospital at Solna, particularly with the layout of the new NICU patient rooms and intensive care areas. In Huddinge, the ICU is open and across the hall from the patient rooms, while in Danderyd, the ICU is enclosed in a large room at one end of the NICU.

The new Solna facility will have bays of four patient rooms in one area with a central nursing station for more flexible care. The goal is to have patients stay in one room and receive as much care as possible there without being moved.

In addition, everything from room layout to medical charting software is standardized so staff can move from one ward to the next and be familiar with the equipment and programs.

Karolinska Institutet and its hospitals are building upon years of research and experimentation and the new facility will provide new levels of insight into NICU care.

My trip to Sweden showed me the importance of sharing information and design ideas. I think it’s essential to pursue greater collaboration among healthcare professionals, organizations, patients, architects, designers, and researchers, so that NICU design can continue to evolve in North America, as well.

Gloria Cornell is an interior designer at B+H Architects (Seattle). For more photos and updates on her travels and the development of her research, visit http://iida-northernpacific.org/knowledge-fund/.  

For more on NICU design, check out:

Considering Cultural Needs In NICU Design

Integration Of NICUs Into Hospitals