New Approaches To Planning Emergency Departments
Emergency departments are evolving as healthcare organizations address the changing needs of their patient base. EDs often serve as a melting pot where diverse demographics converge with a range of medical emergencies.
Immediate, coordinated response from caregivers is essential. Here, perhaps more than any other hospital department, stress runs high and pace runs fast. Well-planned EDs promote efficient flow between first-responders, caregivers, patients, and family.
Several factors impact the planning of efficient EDs.
Patients fall along a spectrum of needs when they enter an ED. Defining those needs in triage is critical to timely treatment. EDs must constantly evaluate their processes and staffing to move patients in, through, and out of the department. It’s important that less critical patients aren’t left waiting too long, potentially prompting them to leave without being seen. Rooming patients immediately, providing fast-track rooms, and adding separate results waiting areas help reduce long wait times.
Safety and security
Safety and security are a concern for patients, caregivers, and families. People enter an ED for many reasons, from heart attacks to victims of crime to mass casualty situations. In addition to assessing patients’ condition in triage, ED personnel must assess extenuating circumstances that could impact safety. Is the patient or family member agitated or unstable? Is the patient a victim of an unfolding crime that could spill into the ED? The design and staffing protocol must implement proper safety standards such as locked entries, security cameras, safe zones, and security guards.
Behavioral health cases have always been present, and addressing the needs of these patients is increasingly getting more attention. Providing safe care for behavioral health patients includes a safe zone for other ED patients, staff, and caregivers in volatile situations. Staff must be trained to address patients who could pose a potential threat to themselves or caregivers.
Families are always part of the emergency department and their needs must be considered alongside the patients. Decentralized waiting within the unit, for instance, allows family to be close by in lieu of waiting in a remote lobby. Other considerations include providing for patient/family privacy, adequate wayfinding, and a place for grieving families.
Mass casualty seems to be in the news a lot these days, from open shooter situations to plane or train accidents. Lean strategies can be used to increase operational efficiency and safety to accommodate a sudden influx of multiple emergency vehicles, patients, caregivers, family members, police, and media.
The recently opened Fairview Southdale Hospital Emergency Department in Edina, Minn., illustrates some of these current strategies in planning EDs.
One is the flexibility to accommodate changing and evolving healthcare requirements. This includes separate patient traffic and staff work spaces to create a quiet atmosphere for patients and an efficient area for staff.
The entire department is built around a universal exam/triage room module to make it both flexible and scalable. As the department traffic ebbs and flows, portions can be opened and closed. An 18-bed observation unit provides space for patients needing extended care while freeing needed treatment space. Additionally, the ED integrates several security features focusing on zones, control points, circulation routes, and egress paths to keep patients and staff safe during different high-stress situations.
That’s just one example of new EDs in the making, and this blog is the first in a new series on ED design, with more best practices to be shared. Watch for the next installment on specifics of accommodating behavioral health patients in EDs.