An integrated design evaluation method for critical hospital units: Combining space syntax and virtual reality for operational efficiency

The design of Critical Hospital Units plays a critical role in operational efficiency. This study presents an integrated evaluation method that combines Space Syntax Analysis (SSA) and Virtual Reality (VR) simulation to assess operational performance before construction. SSA quantitatively identifies accessibility patterns using a Normalized Weighted Accessibility Index (NWAI), while VR immerses users in scenario-based tasks to gather qualitative insights on operational flow. Furthermore, a novel ’Cruciality Level’ metric was introduced to prioritize functional spaces based on operational importance. Cross-analysis of NWAI and Cruciality scores provided a baseline for detecting spatial misalignments that guided the evaluation process. The method was tested on a proposed ED renovation at Nasr City Hospital, Cairo, with six experienced staff from various medical specialties. Findings revealed key bottlenecks: the Blood Lab scored the highest NWAI (0.778) and lowest user rating (3.0), indicating misalignment. The Imaging Zone was flagged for narrow corridors, low visibility, and crowding—despite moderate accessibility metrics—highlighting the limits of geometric analysis alone. In contrast, the Resuscitation Room and Triage scored low on NWAI (≤0.313) and high in Cruciality, confirming alignment. The contribution of this study is a method that bridges spatial analytics with experiential validation, supporting evidence-based, user-centered design in constrained healthcare renovations.