Design Ideas For Hospital Ambulance Bays
Ambulance bays connect EMS personnel and their patients to the triage area of a hospital and should be fast, safe, and efficient at getting everyone in, and out. Yet not all bays are created equal, and oftentimes they become a dumping ground for excess supplies and waste, or a holding area for backboards waiting to be cleaned before they can be used to transport patients again.
“I’ve seen so many bays where you have to wheel patients by mounds of garbage and overflowing bins of biohazard materials because that’s where they store it,” says Don Sharpe, senior paramedic, emergency medical services, Alberta Health Services (Calgary, Alberta).
At the heart of the issue, Sharpe says, is the fact that these are shared spaces within a hospital, and various parties—including ED staff, facility operators, and EMS personnel—often aren’t on the same page about how they should function or be designed. There’s also an accountability issue, with EMS personnel who aren’t employed by hospital systems squaring off against ED staff over who should clean up. “If the door breaks, it’s a facility maintenance issue,” he says. “If the ambulance bay isn’t clean or equipment is left there, who do you call?”
Two years ago, Sharpe, who has a 30-year career as a paramedic, was exposed to Lean thinking and decided to apply the principles to creating design requirements and operations guidelines for hospital ambulance bays. He teamed up with Jason Laberge, human factors specialist for patient safety, Alberta Health Services, and together they conducted 31 interviews with urban and rural EMS personnel, using a large metro hospital ambulance bay to identify issues and opportunities for improvement.
“The most common design error made in designing hospital ambulance bays is any attempt to make them too versatile,” he says. “These aren’t storage areas; they’re specific work spaces.”
Sharpe calls them “intermediate patient care areas” and says the design solutions should take into account clearing patient pathways, improving workflow by reducing staff steps, and enhancing efficiencies. For example, access to supplies shouldn’t be affected by ambulance parking and/or patient access routes to the ED. In addition, the interior of the ambulance bay should be kept bright with painted walls and ceilings, as well as artificial and natural lighting.
As part of their report, Sharpe and Laberge drafted an ideal ambulance bay design concept (see diagram) with a number of design features, including:
- Angled parking so that parking doesn’t impede access to the bay, access to the ED, or egress (#2 on diagram)
- Mop bucket and disposal stations located between every two to three ambulances (#6)
- Dedicated wheelchair and stretcher parking to ensure they don’t congest the ambulance bay or block access paths to the ED (#12 and #13)
- A centralized EMS supply room that’s accessible from inside the bay with doors that open/close automatically using swipe-card secure access (#15)
- An EMS office that’s easily accessible from inside the bay but far enough away from ambulance traffic and exhaust. The EMS office would have up to six workspaces for an 11-unit ambulance bay (#14).
Since introducing the layout diagram last year, Sharpe says he’s met with several facilities and has had varying success in getting them to recognize problems and address some common design issues. It’s a culture shift, he says, but one that must be made as part of an organization’s efforts to improve the patient experience, maintain a clean and safe facility, and keep staff and visitors happy.