Evidence-based design is certainly not a new concept in the healthcare industry. In fact, it is increasingly applauded by architects, designers, and administrators for its impact on a number of key result areas: clinical results such as the improvement of patient outcomes and promotion of healing; employee-related results including increased productivity and job satisfaction; and financial results such as reduced operating costs and improved economic performance. What has not been as closely examined is its impact on day-to-day efficiencies such as traffic flow. The following case study demonstrates how the application of evidence-based design will have a significant impact on traffic flow and operating efficiencies.

A Compact Design

Although hospitals have historically been a maze to navigate, the replacement design for East Cooper Regional Medical Center—a 100-bed acute care hospital in Mount Pleasant, South Carolina—paid special attention to providing a compact footprint for wayfinding and clarity. The five-story replacement facility, located less than one mile from the existing hospital, is initially designed for 150 beds with infrastructure to grow to 250 beds, allowing it to serve the growing needs of South Carolina's central coast


First floor
First, foot traffic was analyzed to identify how to increase efficiency in moving patients between floors. Our design concept was driven by a desire to minimize travel distances between clinical services, but still maintain a clear separation between the public and staff/patient traffic flows. Ultimately, we wanted the building design to minimize downtime caused by traffic issues, allowing staff to spend more time on patient care and less time on moving from area to area.

Second floor
On the first floor, the emergency department, which can be closed off from the rest of the hospital if necessary, has a separate ambulance entrance with an enclosed decontamination shower. From the waiting area, patients are triaged and either referred to express care or taken directly for treatment to one of 22 enclosed exam rooms or specialty care rooms, including the trauma room, gynecology/OB room, ortho-cast room, ENT room, or isolation room. Reducing time and public exposure for what is one of the most common transfer activities, the diagnostic imaging suite is adjacent to the ER. Diagnostic imaging is also easily accessible to patient care/staff elevators to serve inpatients more efficiently.

The surgical services area on the second level features well- integrated functional space design. Eight general operating rooms (with space for two more) are served by an adjacent central sterile workroom. Two endoscopic rooms with an adjoining scope processing room and two pain-block rooms are located next to the ORs. The prep/hold area includes 14 private rooms, with every two rooms sharing one toilet room. The postanesthesia care unit includes 10 open bays and two enclosed isolation rooms. Located centrally between prep and PACU is an eight open-bay Stage II recovery area. An OR control station is positioned centrally to permit observation of traffic into the surgical suite, endo, and pain-block areas. Staff needs were considered, as well—changing and lounge facilities are located centrally, and force one-way traffic to maintain a clean flow into the OR. Finally, the laboratory and pharmacy are both located on the second floor to support the surgical suite, and are located adjacent to the staff elevators for easier access to the patient floors
Third floor

Designed to mirror the progress of a patient's healing stages, the third floor will feature a 16-bed intensive care unit contiguous to a 20-bed progressive care unit. The opposite wing will house the 32-bed medical-surgical unit. Another 32-bed medical-surgical unit, which stacks with the third floor's, is planned immediately for the fourth level, with another 36-bed unit shelled and sized for the opposite wing. The east wing of the fifth level, dedicated to women's care, will have a 36-bed post-partum and women's unit in one wing, with six LDRPs, nine LDRs and two triage assessment rooms. There will also be a C-section suite with two ORs and support. The west wing has 36 postpartum and women's services rooms, a 10-bed NICU, and a 16-bed nursery.

A Holistic Approach to Patient Healing

Fourth floor
All rooms in the replacement hospital are single patient rooms to reduce the likelihood of nosocomial infections, with handrails provided between the bed and bathroom to minimize slips and falls. Rooms were designed to accommodate family members, with dropped ceilings at the windows to make the room cozier, wall sconces for decoration, and sleeper sofas. Family comfort becomes increasingly important as the role of the family in patient healing is recognized and appreciated.

Floor-to-floor heights were raised from 12 to 16 feet on levels one and two and 14 feet on floors three, four, and five. On the first two floors, the higher ceilings provide adequate space for MRI and other large equipment, while on the patient room floors, the 14-foot ceilings create an environment reminiscent of today's modern home design. The added height is functional, as well as aesthetically pleasing, and it also accommodates new building code requirements such as air conditioning and airflow filtration rates.

Fifth floor
Other design-based advantages include the maximization of daylighting and patient views and the introduction of natural elements like water, light, aromas, and natural woods in patient rooms to support healing. On the exterior, the building footprint was minimized to allow additional green space, while a unique storm water system directs rainwater into a retention area of bioswails and collecting ponds where natural vegetation can flourish and be seen from patient rooms. This system also eliminates the need for dimensional storm water systems.

Maximizing the Impact of Design

With an aging population and increasingly sophisticated healthcare delivery driving one of the largest hospital building booms in history, architects, designers, and administrators understand how better design can help speed patient recovery and increase efficiency in delivering care. In the case of East Cooper, minimizing travel distances between clinical services, providing clear separation between public and patient/staff transport, using repetitive and economical stacking of patient rooms (which also facilitates wayfinding and security), and recognizing the importance of functional contiguity allowed us to apply evidence-based research that we believe will yield great benefits for patients and staff—and ultimately the hospital's overall performance. HD

Michael Hart, AIA, ACHA, NCARB, LEED AP, is the Executive Vice-President for Harvard Jolly, Inc., Architects. Hart focuses on healthcare planning and design and is one of only five architects in Florida certified and registered by the American College of Healthcare Architects (ACHA).