Healthcare Design - December 2014 - 20

Many organizations are responding to the evolving
marketplace by making operational changes to treat
existing patients in a more effective manner, rethinking layouts that speed up throughput, and improving
aesthetics to make the front door to their hospital as
pleasing an experience as possible.
Keep care moving
Registration and triage have always been the first
stops for patients in the ED, but many facilities today
are beginning to staff these frontline areas with
physicians who can diagnose patients as quickly as
possible and determine if they should move through
the traditional ED process or to a more clinical setting
for nonemergency care.
"By putting a physician there, you get a higher level
of evaluation," says Jeff Brand, design principal and
national practice area leader for healthcare at Perkins
Eastman (New York). "Another advantage is that in
the old EDs, you'd have to repeat your stories many
different times. Now, you have a doctor and nurse
right at the front door, they evaluate you, interview you
once, and that story is the story. There's no room for
further error."
Another change is the expansion of fast-track
care, an approach that's been growing in usage in
the emergency department for some time. Designed
to treat patients with less serious injuries, facilities are
giving fast track more space as a means to improve
service, reduce door-to-provider time, control treatment costs, and reserve exam room beds for those
truly in need.
Smaller exam rooms can be used here and require
fewer pieces of equipment and furnishings, with
many rooms using a recliner or stretcher instead of a
full-size patient bed. As the concept takes off, facilities
are also increasing the number of fast-track rooms
and incorporating separate lab and staff areas, as well
as waiting rooms.
Out of room
Alternative waiting spaces are also growing in adoption as another effort to improve throughput within the
ED. These areas are separate from the main waiting
room and can feature open or semiprivate designs. "If
I'm waiting for an X-ray or a blood test and I'm feeling
OK, then give the exam room to someone who really
needs it and put me in a different type of setting,"
Brand says. "You have to route people to where they
need to be."
For example, the Lenox Hill HealthPlex freestanding
ED in New York uses a separate area for patients who
are waiting for test results or discharge instructions.
The semiprivate cubicles are located in the core of the
main ED and are equipped with iPads.
20

HCDmagazine.com 12.14

Designers and architects say that when space is
available, it's important to include a separate waiting space for fast-track patients, in particular, to
streamline flow and reduce irritability and confusion
among patients and family members in regular ED
care who might question why someone is being
treated faster than them. During the renovation
of the Methodist University Hospital in Memphis,
Tenn., a rapid assessment and results waiting
room were combined into one space. "[Patients]
can still be in a controlled environment, but they're
not taking up an exam room," says Jon R. Summers, principal, BRG3S Architects (Memphis).

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Warmer welcome
Many of the design elements and aesthetics that
have become must-haves in inpatient areas are
also finding a home in the ED. Traditional curtained
exam areas are being replaced with private rooms,
helping to improve patient satisfaction, privacy,
and infection control.
Facilities are also moving away from sterile or
institutional-like settings and adding warm materials and color palettes, residential-style furnishings,
decorative lighting, and artwork.
A renovated ED at ProMedica St. Luke's
(Maumee, Ohio) features a fireplace in the waiting room, wood-like materials on the floors and
headwalls of the private exam rooms, and artwork
throughout the department.
These efforts go a long way toward making a
facility a welcoming and inviting place, Pickerel
says. "A lot of times the emergency department
is the introduction to the hospital for patients," he
says. "A well-maintained space can transform the
perception of care."
For a look at some recent emergency department
projects and design trends, see page 22. HCD
Anne DiNardo is senior editor of Healthcare Design.
She can be reached at adinardo@vendomegrp.com.

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Healthcare Design - December 2014

Table of Contents for the Digital Edition of Healthcare Design - December 2014