Contract | Trends: The Other Front Door

Trends: The Other Front Door

Catherine Gow, October 2009 Download PDF

Until recently, if you had the misfortune to go to an emergency department, it invariably felt like you were entering the building through the back door. This could be unnerving even to healthy visitors, let alone the hospital’s sickest patients who are most in need of care. Due to the large number of patients flowing through emergency departments these days, they could almost be considered the “other” front door of American hospitals. 

For years, emergency departments (EDs) were the most neglected part of contemporary hospitals, and it showed. Waiting areas were grim, uncomfortable spaces where patients often had to endure long delays. As healthcare costs have risen and more people have ended up either under-insured or uninsured, they have increasingly used emergency departments for their primary means of treatment. In the past 10 years, more patients have been admitted through hospitals’ emergency departments than any other way. Still, the diagnosis was dire: most emergency departments were outdated, undersized, and hopelessly crowded.

In the last several years, EDs have finally begun to get the right kind of treatment. Creative solutions are curing the problems of the past and ensuring healthy futures, which is good for hospitals and patients alike. Changes to operational mechanisms and design improvements are resulting in better patient experiences as well as better workflows.

The most significant operational change is that recent EDs combine streamlined design with operational improvements, which facilitates the treatment and discharge of patients. This process begins in triage – the first space that patients encounter. Although triage areas are essentially the “gateways” to EDs, they are frequently also their chief bottleneck. 

To speed up the treatment process, create a calmer patient experience, and reduce waiting times, EDs are also being reorganized with multiple triage treatment rooms. Although they must be enclosed or semi-enclosed to ensure patient privacy, in accordance with the Health Information Privacy Protection Act (HIPPA), there are ways to accommodate this need; one way is to enclose the treatment areas in glass, which allows patients to maintain visibility to and from waiting rooms, where anxious family members may be sitting. Hospitals can even opt to provide additional seating space inside the treatment rooms for spouses or parents, which becomes particularly important when the patient is a child.

As triage areas grow in number, increasing the speed of triage and treatment, the size of waiting areas becomes noticeably smaller. These new design strategies reflect a commitment by hospitals to reduce patients’ waiting time. To this end, many hospitals are integrating “sub-waiting areas” for patients as they travel through the department, along with family waiting areas for treatment or consultation with healthcare professionals.

Beyond the triage areas, the design of ED treatment spaces is moving toward “universal,” flexible spaces. Unlike old treatment spaces that were dedicated to only one use, these treatment areas use mobile equipment for added flexibility.

In 2005, Our Lady of Lourdes Medical Center in Camden, NJ, opened an expansion that features a new 15,000-square-foot ED. Designed to accommodate 50,000 visits per year to keep up with dramatically increased demand, the ED occupies the ground floor of a new seven-story critical care building.  The new ED incorporates a variety of treatment spaces – from open cubicles to enclosed rooms – that provide maximum flexibility and increase the ED’s ability to handle unexpected surges in capacity. 

Specialized treatment carts enable healthcare professionals to perform suturing and other treatments, so that a healthcare professional can treat any kind of medical issue in a single space.  The carts promote efficiency because they minimize staff time that may be spent searching for required materials or equipment. It is most efficient to store the carts and other equipment in or near the treatment spaces. Double-sided equipment counters are extremely useful, because they provide convenient locations for equipment, and their countertops can also be used for charting.

Thoughtful interior design is another key aspect of the ED of the future. Evidence-based design and patient focus groups have shown that interior environments that follow a hospitality model facilitate healing and enhance the patient experience. Warm color palettes soften these transitional spaces. Furthermore, sustainable design principles are increasingly guiding ED interior design; materials such as rubber and linoleum not only meet “green” standards but also require minimal maintenance, while renewable fibers such as hemp and bamboo harmonize seamlessly with the healthcare setting.

The emergency department for FF Thompson Hospital in Canandaigua, NY, employs many of these hallmarks of contemporary ED design strategy. As with many hospitals, Thompson renovated its ED in response to growing patient volumes. Thompson sought to double its capacity and provide more privacy and comfort for its patients.

The ED is designed as a series of four “pods” or clusters of treatment rooms that encircle a nurses’ station at the center of the plan. This layout helps ensure that the medical staff is located near all of the pods. One of the pods remains open at all times, and additional pods can be open or closed, depending on need; patient volumes are especially high during the summer season. This system works well with staffing ratios and ensures that patients have attentive and responsive care.

In addition, there was great interest on the part of the hospital to introduce natural light. The designers added clerestory windows to bring abundant light into all of the public spaces, treatment spaces, and staff workspaces, which is atypical for an emergency department. In this way, the interior spaces of the hospital are connected with the outdoors, and energy consumption is reduced.

In the future, emergency departments will look much different than they do today. Designers are using thoughtful design strategies and new technologies that improve patient comfort, increase satisfaction and boost efficiency. Certainly, no one likes to go the emergency room – or wants to. But, if they have to, emergency departments of the future may help ease the pain of the treatment experience while they cure life’s unexpected accidents.

Back to News