Designing a hybrid surgical ICU to avoid intrahospital transport in selected critically Ill patients: the CUHK-SZ institutional concept

Intrahospital transport for surgery exposes critically ill patients to equipment failure, displacement of tubes and lines, interrupted monitoring, and physiologic instability. Although transport protocols can reduce these hazards, they do not address the underlying physical decoupling of surgical infrastructure from the critical care environment. This institutional perspective describes the rationale and design of a hybrid surgical ICU planned for the Chinese University of Hong Kong, Shenzhen (CUHK-SZ) Medical Center: a dedicated clinical space designed to function as both a critical care unit and a procedural suite, bringing surgery to the patient rather than transporting the patient to the operating room (OR). The model is presented as an illustrative, hypothesis-generating concept rather than a validated clinical pathway. The design concept, which is a patient-centered approach, should guide healthcare delivery in modern medicine by placing the patient at the forefront of all decisions and mobilizing all available resources to serve them. This approach addresses all three domains: personnel, environment, and equipment. Overlapping anesthesiology and critical care competencies support integrated staffing. Connectable ICU rooms, adequate space and electrical capacity, anterooms, and switchable HEPA-filtered positive-pressure ventilation meet environmental requirements. Total intravenous anesthesia, portable surgical platforms, and minimally invasive or robotic techniques reduce dependence on fixed OR infrastructure. At CUHK-SZ, the concept is planned as a prototype in the trauma building using two adjacent ICU rooms with an openable partition and switchable ventilation. Candidate patient groups, procedural levels, and implementation requirements are presented as provisional, expert-derived proposals, and engineering testing and simulated drills are planned before any clinical use. The hybrid surgical ICU is a technically plausible option for carefully selected patients at high risk from transport, but its clinical effectiveness, safety, and cost-effectiveness remain unproven. The CUHK-SZ concept is intended to generate hypotheses for prospective evaluation, and its transferability to existing hospitals is likely to depend on incremental adaptation rather than direct replication.