Advancing technology, electronic medical records, and changing healthcare delivery systems are all impacting the design of healthcare spaces.

It's important for planners and designers to consider the operational processes and workflows associated with these traditional spaces to maximize functionality and flexibility for the future.

Moreover, the Lean movement and accountability for patient satisfaction and outcomes have changed consumer expectations for efficient service and experiences.

  1. Registration and arrival: Scheduling and registration for outpatient testing, inpatient and outpatient procedures, and office visits are accomplished via the phone or Internet in most facilities. Many organizations have seen pre-registration and co-pay collections approaching 95% and over, thus eliminating the need for typical registration areas. For the majority of patients who are pre-registered, the arrival process is a brief check-in process that can be completed centrally at an arrival station or at the point of service.
  2. Patient rooms: Private rooms with traditional care and family zones have been common for more than a decade. More emphasis is needed on patient mobility, safety, staff efficiency, and flexibility. Design experts have traditionally focused on the patient bed as the center of the room. However, the location of the patient chair is just as important to maximize mobility to improve patient outcomes. The path of travel to the patient bathroom needs to be short, unobstructed, well lit, and feature hand rails in easy reach. Fixed computers and built in casework are giving way to handheld and portable devices that are located in the caregivers work space at the bedside, while supplies are frequently kept in mobile carts at the bedside.
  3. Triage rooms in the ED: Triage is a process, not a space. Most emergency departments have implemented immediate bedding concepts with standard exam rooms designed for maximum flexibility. During times of surge and capacity in the ED, it's necessary to have private space that allows for sorting (triage) and rapid assessment of patients. However, this function can be accommodated in a nontraditional exam room.
  4. Interventional and perioperative services: Cardiac catheterization and interventional radiology procedure rooms are rapidly becoming part of the overall surgical interventional platform as a result of guideline changes requiring standardized sterile environments. Sharing these spaces with surgery is a change for providers and should consider corresponding adjacencies such as diagnostic cardiology and imaging services to enhance provider efficiency. The sharing of procedural prep and recovery spaces between surgery, cardiac catheterization, and interventional radiology provides staffing efficiency and standardized care practices and protocols as well as peer support in areas with low volume.
  5. Health information management (medical records): With electronic records, storage space is minimal and HIM professionals should be challenged to consider decentralization of traditional services such as scanning, coding, and release of information at the point of service rather than in a central location.

In the rapidly changing accountable care environment, our challenge as healthcare planners and designers is to stay ahead of technology and care models so that space is flexible to the changes in healthcare we'll see in the next few decades.

Terry Thurston is the Director of Healthcare Operational Planning at BSA LifeStructures and brings more than 30 years of healthcare experience as an expert in operational, occupancy, and transition planning. Her experience as a chief nursing and patient safety officer allows her to bring a multi-faceted approach to designing safe and efficient healthcare facilities.