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The Leaflet Article

Featured Article:

The art of Emergency Department (ED) Design

By Jerry Switzer, AIA, NCARB, ACHA, and Dale Taglienti, LEED AP Partners E4H Environments for Health Architecture

Today more than ever, forward thinking healthcare systems are reimagining their facilities with an eye toward enhancing the patient experience and improving outcomes. Healthcare design in general and Emergency Department (ED) design in particular are being shaped by a more discerning public who are expecting to be placed in a supportive environment which offers them much more control of their experience. Greater individual privacy, fewer disruptions, and quicker responses create a better clinical environment for patients under circumstances that by definition are not conducive to doing so.

The art in ED design is to solve ED crowding while reducing operating costs and improving outcomes.

Humanizing EDs

In most EDs, open bays have long been replaced by enclosed rooms which have proven to diminish stress and provide protection from the stress of others. This is particularly important in pediatric care where exposure to the stress or fear of others can be counterproductive to diagnosis and treatment. 

The concept of separating points of care into clusters of like-mannered needs such as trauma, acute, non-acute, behavioral and pediatric care are thoughtful designs explored to one degree or another in most EDs with the intention to break the larger number of overall visits into more manageable operating zones. The challenge is to provide for the care modules and at the same time allow for flexibility of room assignment should one population experience a surge. As such, E4H recommends making every exam room as much alike in size and set-up as possible.

The E4H-designed ED at Central Maine Medical Center (shown below) takes the concept of separation even further by grouping exam rooms around a central core surrounded by a perimeter corridor. Each exam room has a door from the core for staff and from the perimeter corridor for the public. Separating the staff core from the public pathway makes HIPPA compliance easier, and contains staff discussions and work to a more private zone.

Floor Plan Internal Staff Core

Door to Docs

EDs around the country are under a lot of pressure to take care of increasing volumes while reducing the time in the ED. The goal for many EDs is to reduce the interval from the time a patient enters to being seen by a provider to 10 minutes.

The concept of “Quick Treatment” or “Rapid Triage and Treatment” is proving to be an effective way to manage the treatment of the non-acute (Levels 4 and 5) population entering the ED by creating a separate zone near the entrance from which treatment is delivered and completed without penetrating the main ED itself. Examples of this are in place at Lawrence General Hospital, Lawrence, MA and are being designed by e4h at Elliot Hospital, Manchester, NH.

Once triage determines a patient to be non-acute, they are placed in an adjacent space with chairs offering sit-down privacy for each patient and a companion with enough separation to offer discreet consultation. A provider assigned to the area confirms the assessment and develops or executes a treatment plan. If a private exam or blood drawing is required, a few rooms are available in the immediate area. In most cases, the patient will be discharged directly from this area. Depending on policy and procedures in place, proximity to radiology is a consideration and is most often accompanied by a dedicated results-pending waiting area.

A typical number of patients seen in QT/RTT is 15 to 20% of total ED volume.

Case Study

All of the above concepts were also explored and tested as part of E4H design for the largest ED in Israel at Rabin Medical Center in Tel Aviv. Even though the footprint was 66,000 SF for 150,000 visits, it was determined that not enough treatment spaces could be obtained with the perimeter scheme (would have required an additional 12,000 SF as seen below); instead the 110 exam rooms were subdivided into approximately equal-sized clusters for Trauma/Very Acute, Less Acute, and Non-Acute Ambulatory.


Perimeter Scheme Study – 110 Treatment Spaces Treatment Clusters – 110 Treatment Spaces

No matter the geographical location, the art of Emergency Department Design should demonstrate success in reduced visit time, improved quality outcomes, lower costs, and improved patient and staff satisfaction.

Jerry Switzer

As a founding Partner of E4H Environments for Health MorrisSwitzer, Jerry brings over forty years of experience dedicated exclusively to healthcare facilities planning and design. His projects have ranged from small Community Hospitals to 1,000 bed Medical Centers.

Dale Taglienti

Dale leads E4H Environments for Health MorrisSwitzer Boston, MA office and manages multiple hospital projects in the Greater Boston Area. His 25 years of architectural planning and design experience include the renovation and construction of a diverse array of healthcare projects ranging from Pediatric Ambulatory Care to complex Surgical Centers.

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