Nearly everyone who has seen the popular TV series ER thinks he or she knows what a typical emergency room looks like: doctors scurrying around (and sometimes on) crash carts, people bumping into each other and into various pieces of equipment scattered about corridors, a wild flurry of activity around the central admitting station (with doctors gossiping peacefully within), an occasional chair thrown through a window, and patients sternly told to “wait in chairs” for their turn as chaos breaks out around them. Exaggerated for dramatic effect? No doubt-but there existed enough truth in that picture for physicians in one hospital to decide to do something drastic about it.

At Ball Memorial Hospital in Muncie, Indiana, ICU Medical Director Thomas Gardiner, MD, who is also executive vice-president of Cardinal Health System, the parent company, conceived of an ER where patients and families would be accommodated in private rooms, receiving care with dignity and in relative comfort. This spring will see the opening of this experiment in patient-centered care that is delivered under the most urgent and sometimes tumultuous of circumstances. Recently, Dr. Gardiner, Director of Engineering Brent Bartholomew, and BSA LifeStructures designer Richard Fetz discussed the design process in interviews with HEALTHCARE DESIGN Editor Richard L. Peck.

Thomas Gardiner, MD: “We started with some questions: How can we make the patient experience as good as possible? How can we keep the family together and involved? Why do we need a large waiting area that exposes everyone to patients' distress? What can we do to eliminate stays in the waiting room? Our answers resulted in this design.

“We now have 39 private rooms, each with an associated family space, in an area about 60% larger than the typical ER. The ER is divided into urgent and less urgent areas, with triage meeting patients at the door and assigning them to the appropriate rooms. Each room is equipped in the same way except the more trauma-oriented rooms, which have advanced resuscitative equipment. Each room has chairs for the family and a TV, as do the family rooms across the corridor where families can wait when the patient needs complete privacy. Physicians go to the rooms, as needed.

“Located in the area are dedicated digital x-ray and computed tomography facilities, so that patients don't have to travel far and films are readily available to staff-a bit of a staffing challenge that had to be worked out.

“We have aggressive goals for this operation-turnaround of less than two hours for more acute patients and less than 60 minutes for less urgent patients. Needless to say, this high-volume, high-speed operation needs to be done impeccably well to maintain quality of care. We've also had to make some unusual decisions about equipment-for example, rather than have just a select few carts be gynecologically capable, we've made them all that way for maximum flexibility; this cost a bit more, but it helps us avoid having to shuffle patients around.

“I received some interesting initial reactions to this idea, but let's face it: Waiting rooms are unpleasant, and the only way to avoid forcing people into them is to not have them in the first place. This is thinking outside the box, and to do that, you have to keep patients and families in mind, first and foremost.”

Brent Bartholomew: “From a construction standpoint, this is probably the most basic building I've been involved with: slab-on-grade, bar-joist steel construction, isolated from the rest of the building. The equipment layout and demand are not much different from that of the standard ER. The patient/family service aspect has been the most challenging concept to adapt to; it is difficult to staff in terms of the caregiving paradigm and processes, but I'm convinced it can work. Also, there are more storage areas and less clutter, and the curved corridors and interior design give it a more homelike feel. There is better visibility for staff through the glass doors in the trauma care rooms, and the traveling distances for staff may actually be less than they were in the old ER.”

Richard Fetz: “We had originally designed a traditional ER, with a walk-in entry, ambulance entry, and large waiting room in the back of the hospital, to replace the old ER in the same location. Once the hospital decided to embrace a philosophy of making the patient ER experience more acceptable, with no waiting room and individual rooms for patient privacy, it provided a great opportunity to transform the design paradigm of what an ER looks like and how it functions. With this new design, the increasing concern for patient privacy is addressed.” HD

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Healthcare Design 2003 May;3(2):44-45