Reimagining Emergency Departments Through Design

By Hillary Eames
Monday, January 6, 2020

Maximizing the flow, function and aesthetic of emergency departments could be an effective way to improve the quality of emergent patient care.

Many hospitals are expanding their emergency departments to meet the growing needs of their patients. With the increased longevity of patients with chronic conditions, the aging baby boomer population and a limited number of resources to help patients receive primary care, it is no wonder that nearly 50% of all medical care in America begins in emergency departments, according to the recent data. To provide quality care to a growing community of patients, many facilities are looking for ways to improve the functionality of the department that is commonly known as the hospital’s front door.

“By their nature, emergency rooms are a critical function within any hospital,” says Jim Langlois, AIA, AP, Healthcare Executive Vice President at design consulting firm Gresham Smith. “For the community, effective access to their emergency department is essential.”

Trends Identified in Emergency Department Design

To understand how to better meet the needs of current and future patients, Bryan Langlands, AIA, ACHA, EDAC, LEED GA, Principal with NBBJ, Durell Coleman, MS, Founder and CEO of DC Design, and Troy Savage, MESc/MDiv, Project Manager at Mazzetti, co-authored a white paper titled “Reimagining the ED: Ideas for Shaping the Emergency Department of the Future.” Langlands, Coleman and Savage gathered their information from design professionals, students and emergency department clinicians during a workshop held at the 2017 Healthcare Facilities Symposium & Expo in Austin, Texas. Their white paper, published by the Facility Guidelines Institute in December 2018, identified three main changes healthcare facilities can implement to improve their emergency departments:

  • Using technology to improve arrival and front-end operations for all patients
  • Reducing the length of stay for less-acute patients
  • Creating spaces for behavioral health patients

Improving Patient Arrival

Langlands et al. recommend using technology to streamline the registration process for simpler patient sign-in, sorting and waiting times. Namely, they suggest a registration kiosk for low-acuity patients and bracelets to monitor patient vitals. Langlois’ suggestions, while more generalized, are still crucial in the reimagining of successful emergency departments.

“Ideally, the wayfinding to an emergency department is intentionally simplistic,” he says, listing three essentials: “A bright red sign, an obvious entrance and medical staff immediately there to help the person in need.”

Shortening Non-Acute Stays

Treatment of nonemergency patients in spaces designed for more acute patients can affect patient wait time and care. As a solution, Langlands et al. suggest offering smaller spaces to “vertical” patients or creating spaces that can host multiple low-acuity patients at one time, limiting the amount of time both low- and high-acuity patients spend in the emergency department. Waiting rooms can also be zoned based on emergency severity to help identify low- and high-acuity patients, decreasing wait times in the process.

Behavioral Health Spaces

Traditionally, emergency departments are not designed with the treatment of behavioral health patients in mind and, as a result, these patients often do not receive optimal levels of care. Langlands et al. state that patients with behavioral health issues often stay in emergency departments for two to three days before being transferred to an inpatient facility or a psychiatric hospital. Additionally, an overflow of behavioral health patients are, in many cases, assigned to emergency department beds and resources. As a result, those patients may receive suboptimal care for their health concerns and limit resources available to other emergency department patients.

Spaces in or close to emergency departments specifically designated for behavioral health patients are necessary to ensure that they have access to appropriate care; otherwise, neither behavioral health nor other emergency department patients are able to receive the services they need.

Balancing Functionality with Patient-Centered Care

The requirement for efficiency in emergency departments must coexist with the need to provide patients, physicians and staff with patient-centered environments and care.

“Emergency departments are often designed to solve functional requirements first, while other considerations can be marginalized,” Langlois says. “[They] are inherently busy and stressful places. It’s imperative that designers refocus attention on mitigating anxiety and sensory stress [by] creating clear circulation paths, minimizing noise and visible technology, and incorporating other evidence-based practices [that] can help balance the need for efficiency with a human-centric approach.”

For this reason, many hospitals are seeking input from their surrounding communities, asking patients, families and front-line staff what they believe could be improved. Some facilities are also moving toward freestanding emergency departments to provide potentially lifesaving care closer to patients’ homes.

Langlands et al. also noted that many of the issues brought to their attention centered less around emergency room design and more around the process through which patients receive care. They describe emergency departments as “processes” rather than “places,” and problems arising from outside factors, such as an aging population, may contribute to obstacles in emergency department care more than design or operational changes. Still, these experts contend, a forward-looking reimagining of the emergency department is necessary to ensure patients will continue to receive quality care in the coming years.