Earlier this week, the HEALTHCARE DESIGN Editorial team was given a tour of the Cleveland Clinic Richard E. Jacobs Health Center in Avon, Ohio. The 190,000-square-foot center for advanced specialty and primary care, includes an outpatient surgery center, infusion suite for chemotherapy, full scale imaging center and a retail optometry and pharmacy on site.

A 24-hour emergency department with helipad will open in late summer, but the design --as explained by Geoffrey Aiken, AIA, LEED AP, and Michael Ball, AIA from design firm URS -- was executed with the future in mind; a future that has now come to pass.

The ED was designed with a flow to accomodate the influx of newly insured patients that will be presumably flooding emergency departments around the country. The theory is that these previously uninsured patients will hit the ED because they either do not have primary care physicians to go to for minor things like the flu or small injuries, but also because the ED is where they are used to going when their illnesses in the past have worsened to the point of needing a doctor's care.

Regardless of why they get there, the ED is looking to get even more crowded than it already is, and the URS team acted proactively to circumvent the issue. Patients are routed into a small triage area and immediately assessed as high or low acuity. Low acuity patients are routed one way, to a smaller section of the ED with curtained cubicles where they can be given meds or prescriptions, then sent back out the door towards home. Higher acuity patients are routed the other way, towards either a traditional ED exam room or an observation room located between the two sections. The plan is to keep the high acuity beds from being tied up with easily treated and discharged patients who come to the ED when they really should be seen by primary care; in theory, at least, it should work perfectly.

This "split flow" design sounds simple, but the predictive thinking behind it shows a forward-thinking idea executed well. Will more EDs start to split their flow now that the Supreme Court has made its ruling? I would think so, but facilities that planned ahead like the Jacobs Health Center would seem to have a leg up in dealing with the crowds for the near future.