Creating spaces in intensive care for safe communication: a video-reflexive ethnographic study

Area of Science:

• Healthcare design
• Patient safety research
• Clinical communication

Background:

• The built environment in acute care settings is an emerging area in patient safety.
• Limited research exists on ward design and material object choices (e.g., light fittings, basins).

Purpose of the Study:

• To explore how clinicians utilize the built environment for safe communication in an intensive care unit (ICU).

Main Methods:

• An interventionist video-reflexive ethnographic (VRE) study was conducted in a Sydney metropolitan hospital ICU.
• Included 40 semistructured interviews, 5 weeks of observation, and 4 focus groups with 87 healthcare staff.

Main Results:

• Open spaces in the ICU presented both safety benefits (communication flow) and risks (interruptions).
• Staff created temporary protected spaces using physical markers (curtains, tape, signs) and behavioral cues to manage interruptions.
• Clinicians used the VRE method to analyze and solve practice-related problems.

Conclusions:

• ICU staff create safe communication by establishing temporary spaces that are both 'connected' and 'protected'.
• These flexible 'soft' strategies are highly effective in the fast-paced intensive care setting.