Emergency Departments Design Book

We are not architects who do healthcare. We are healthcare architects

What does this mean?

It means we chose this profession so we can do more than just design buildings. We chose it to design solutions that can change people’s lives significantly. Because when a transplant patient receives a new heart, or a mental health patient reaches a breakthrough, or a physician develops a medical procedure that improves the lives of thousands, it happens inside a space designed by a healthcare architect. This is why we arrive every morning with our sleeves rolled up and ready to work.

Our Firm

in Brief

With four decades of experience serving healthcare clients, we’ve learned that it’s never just about the building. Every problem and challenge our clients face are unique opportunities to adapt, improve or transform—and they all require something different.

That’s why we are so much more than just healthcare architects. Our integrated services align analysts, advisors, and architects to provide a complete continuum of project exploration and execution.

Guided by process, powered by collaboration, and built around an innovative culture

100%

40 dedicated to healthcare planning and design

5 strategically located offices throughout the country:

• Philadelphia, PA

• Charleston, SC

• Fort Lauderdale, FL

• New York, NY

3

unique perspectives for a comprehensive approach:

• Architects

• Advisors

• Analytics years serving healthcare clients

• Washington, DC

ARCHITECTS | WE ARE DESIGN

Array Architects is committed to improving healthcare outcomes by providing design solutions informed by integrated insights from perspectives across the organization.

No brick is placed without considering its placement. No wall is raised without determining its integrity. No systems are installed, no colors are applied, no impact is made without a careful reasoning for doing so. We don’t address needs—we address your needs—taking into account the context of a project and assembling a roster of experts whose combined strengths align to give your project life, value and spirit beyond its basic function.

• Healthcare thought leaders

• Cross-disciplinary teams

• Process-led Lean design

• Data-driven decision-making

• Customer-focused design

ADVISORS | WE ARE STRATEGY

Array Advisors is a multi-disciplinary team providing custom solutions to optimize healthcare operations and solve business challenges.

When addressing the distinct needs of any healthcare business, there is no solution without informed preparation and consideration. It requires a nuanced approach of dedicated professionals with a variety of viewpoints. We uncover the opportunities buried within your challenges by untangling the complexities of those problems, and then engineering a solution using industry-leading tools and techniques.

• Capacity analysis

• Strategic planning

• Change management

• Lab & pharmacy optimization

• Lean operational improvement

• Transformation

ANALYTICS | WE ARE TECHNOLOGY

Array Analytics is an innovative think tank of analysts and product developers dedicated to helping healthcare systems identify and contextualize business drivers.

These days, big data is critical to making informed decisions, but information must be distilled and interpreted to truly be valuable. To ensure the quality and accuracy of our data, we created a technology incubator within our firm, which has evolved into Pivotal Analytics. Pivotal is a subscription SAAS platform enabling our customers access to a powerful geospatial-based claims-driven demand analytics.

• Data integration

• Market analysis

• Predictive analytics

• Real estate strategy

• Strategic capital allocation

Integrated Our Services

STRATEGY

We are an innovative think tank of analysts and product developers dedicated to helping healthcare systems identify and contextualize business drivers.

• Market analysis & demand forecasting

• Dynamic scenario planning

• Consumer segmentation & profiling

• Identifying optimal service locations

FACILITIES

We are a multidisciplinary team that provides custom solutions to optimize healthcare operations and overcome business challenges.

• Facilities assessments

• Programming and pre-design

• Feasibility & CON studies

• Architecture & interior design

• Patient experience design

OPERATIONS

We are committed to improving healthcare outcomes by providing design solutions informed by integrated insights from perspectives across the organization.

• Throughput analysis & simulation modeling

• Process design & value stream mapping

• Clinical practice modeling

• Design thinking & Lean education

• Lab & pharmacy optimization

Array Architects

Array Architects is committed to improving healthcare outcomes by providing solutions informed by integrated insights across the organization.

DESIGN & ARCHITECTURE

Our firm develops and implements concepts that emerge as transformative built solutions. Array remains focused on the healing that will take place within our clients’ facilities and the lives affected by the building’s shape, performance, and functional adjacencies. As a healthcare-exclusive practice, our focus is singular, and our commitment to a collaborative approach facilitates operational excellence and drives innovation.

PLANNING

Array goes to great lengths to substantiate our solutions with hard data. Our pragmatic process, intensified by our unique planning toolkit, enables more-informed decisions to maximize flexibility, efficiency, and return on investment.

INTERIOR DESIGN

Beyond creating beautiful spaces influenced by hospitality, we have a responsibility to bring the latest evidence, benchmark data, lean thinking, and examples of successful projects into the design process. By doing so, we help our clients realize their full potential to drive a change in culture, improve patient outcomes, increase patient satisfaction, and foster an environment of collaboration.

PROJECT OPERATIONS

Array is committed to project management, acting as center of excellence for this practice. Our clients are confident in the consistent high-value delivered through their built initiatives.

Array Advisors

Discovering Your Healthcare Solutions Together.

We help clients deliver more efficient and effective care, stake a more competitive position in the market, and plan to ensure facilities embody their operational vision.

STRATEGIC PLANNING

Reach consensus around strategy to supercharge your plan for the future. We work with health systems to develop strategies that drive sustainable business models across the continuum of care.

MASTER PLANNING

We have learned that while master planning engagements can transform an organization, the outputs of the traditional process are inherently broken. Master planning teams either omit the necessary perspectives, or these roles are siloed or filled by external consultants, creating delays and limiting rapid re-assessments. As Lean planners, we improve the value of master planning by redesigning the process. Array not only facilitates discussions between key stakeholders representing different perspectives, but our team brings its own functional expertise. The team’s broad experience builds credibility with stakeholders across the organization and advances data-driven discussions of needs and priorities.

PRE-DESIGN PLANNING & OPTIMIZATION

Lean is an operational strategy that can be used to achieve specific goals defined by your organization. Our experience extends from strategic decision making, where we help you define organizational goals, to tactical workflow analysis, where we assist in developing countermeasures appropriate to your specific situation. We use this as a foundation to develop a more robust program alongside your leaders setting your project up for success as design begins.

Visualize the Possibilities, Plan for Reality.

Pivotal is a dynamic business planning and optimization software platform for healthcare capital projects. But most impressively, it’s simple, instant, and once the inputs are set, changes are as easy as the drop of a pin.

WHAT IS PIVOTAL?

Pivotal is healthcare planning transformed. It’s an integrated and collaborative analytics platform for healthcare business planning and strategic optimization. It’s a living tool that helps you visualize the path to success for today, the challenges you should avoid tomorrow, and the opportunities you never saw coming.

Pivotal provides comprehensive market and patient data, operational capacities and financial models all under one unified framework.

Architecture is about relationships.

Relationships with spaces, objects, and most importantly— people.

EMERGENCY DEPARTMENTS

The highly visible and rapidly evolving field of emergency medicine faces challenges that include growing patient volume and shrinking physical capacity. Hospitals view the emergency department as their “front door,” with over 50% of admissions coming through the ED. Consequently, hospitals have increasingly focused on patient satisfaction and flexible design models to accommodate fluctuation in census, disaster response, and infectious disease management.

There is no cookie-cutter approach to the design of a state-of-the-art emergency department. Each facility must be evaluated based on its own unique needs and the needs of the community it serves. One “moving target” which has significant impact on the operational effectiveness of the emergency department is annual patient visits—with the ED a common first-stop when illness strikes, staff need to be able to respond quickly to an uptick in seasonal viral outbreaks and other, more critical infections that can quickly fill an ED waiting room.

We utilize process-led Lean design methods and simulation modeling on our projects to ensure efficient ED throughput and operations. These tools, along with others in our process toolkit, allow us to identify and resolve root causes of long patient waiting times and thereby increase patient satisfaction.

INSPIRA HEALTH

Greenfield Hospital Split-Flow Emergency Department

Mullica Hill, NJ

Designed by Array, Inspira’s five-story, 460,000 SF greenfield replacement hospital in Mullica Hill serves a diverse patient population, ranging from families with small children to seniors. Within the hospital, Array was tasked to create an emergency department that provides optimal operational performance and is rightsized to serve the community.

To properly scale the new ED and inform patient flow design, Array built a simulation model using readily available data, including average length of stay, patient mix, and arrival rates. Further analysis led the design team to recommend a split-flow model that

incorporates 22 general, 14 geriatric, six pediatric, and six behavioral health private treatment rooms. An additional two trauma rooms and 12 vertical treatment bays allow for overflow of low acuity patients when the ED is at full capacity.

The design features same-handed rooms organized into pods (to allow flexibility between acuity zones), sliding glass break-away doors, bedside charting, and dedicated family space with integrated device charging. The ED was strategically located within the new hospital to allow for future expansion without negatively impacting other departments.

Inspira embraced “family as a partner in care” by reducing stress and promoting dignity through comfortable and colorful patient and family spaces. This is especially prevalent in the pediatric portion of the ED, which maintains its own waiting room, family lounge, and four inpatient rooms to ensure the safety and privacy of all children and adolescents. In the geriatric pod, all rooms include private bathrooms for additional comfort and dignity and a low contrast color palette.

RWJBARNABAS HEALTH

New Brunswick Campus Emergency Department Expansion & Renovation

New Brunswick, NJ

The transformation of RWJBarnabas Health’s New Brunswick campus emergency department is a response to the evolving landscape of consumer-based patients, “retail” healthcare providers, and portable technology. This 60,000 SF expansion and renovation project increased existing ED space by 50% and potential patient capacity from 42 to 100.

A Level 1 Trauma Center, the new ED features design details that adhere to an elevated, consumer-focused model that enhances

patients’ emergency care experience. It is comprised of a rapid-evaluation triage approach, care initiation area, 54 treatment beds, pediatric ED services, resuscitation, imaging, and a behavioral health unit. Customized focal lighting and wood-look ceiling details, coupled with glass sliders on patient rooms and a cool color palette offer distinct wayfinding and reduce patient anxieties while honoring the facility’s strong, existing brand.

RWJBARNABAS HEALTH

New Brunswick Campus

Pediatric Emergency Department

New Brunswick, NJ

The new pediatric emergency department at RWJBarnabas Health’s New Brunswick campus is an integral part of the multi-phased emergency department expansion and renovation project that began in 2013. Our team was tasked with designing a space that would appeal to the diverse interests and needs of RWJ’s pediatric patient population consisting of varying age groups and including those with special sensory requirements. The upgraded space features 17 large, private bays, a results waiting area, a three-bay behavioral health area and a groundbreaking sensory (Snoezelen) treatment room, the first of its kind in the state.

Nurse stations were specially designed out of curvilinear forms that are both soft and undulating, fostering a safe environment and playful childlike essence while also offering maximum visibility to all rooms

and corridors. Patient rooms can be easily identified by designated color groups, forming neighborhoods that improve patient wayfinding and operational flow. In each neighborhood, abstract artwork installations are integrated to appeal to all age groups, displaying myriad natural elements composed in bubbles.

The addition of a designated sensory treatment room allows specially trained clinicians to care for patients with a variety of special needs in a sensory-friendly clinical environment. The room was designed and developed with the key considerations of maximizing patient sensory control and family engagement through color-changing lighting, water features, and wall projections, with careful attention to infection control and maintenance essential to the emergency care environment.

RWJBARNABAS HEALTH

Ambulatory Building Expansion & Renovation

New Brunswick, NJ

As part of an overall strategy to modernize and provide additional service line capacity at their New Brunswick campus, RWJBarnabas Health sought to improve front-end flow in their emergency department, relieve overcrowding, as well as enlarge and modernize their ambulatory facilities.

Array’s solution reconfigured ambulance parking and expanded their ED and ambulatory care center by 8,100 SF, all while maintaining a cohesive exterior design. The addition provides a new walk-in ED entrance, expanded surgery

waiting area, ED waiting area, and shell space for a 21-bed observation unit to address capacity and patient flow issues.

This project also involved connecting two structurally independent buildings and an existing freestanding bridge directly over a below-grade parking deck. Phasing and logistics were closely tied to (and coordinated with) another Array project occurring concurrently on the opposite side of campus. Both projects took an overbuild approach, a strategic decision for the landlocked facility.

The waiting and public lobby is one of the first spaces patients and families experience when arriving at the campus. The space has a presence from both the interior and exterior, giving the design team the opportunity to make a statement. Linear decorative panels frame the main elevators, drawing attention to the information desk as they wrap the ceiling into the two-story space.

Waiting pods throughout the large, open area provide families with the semiprivate space they desire while waiting for loved ones in surgery. A range of seating options are provided, from touchdown to plush lounge, all with immediate access to power and data.

MAINEHEALTH

Psychiatric Emergency Department

Sanford, ME

Array teamed with MPA Architects and converted three underutilized patient units to create a behavioral health center of excellence at Southern Maine Medical Center. Included in the program was an upgrade to the emergency department’s acute psychiatric unit to strengthen behavioral health intake.

The facility previously utilized two secure holding rooms within the ED, which lacked the security and safety features commonly seen in psychiatric emergency services. In addition, with the addition of 40 inpatient psychiatric beds to the facility, MaineHealth realized their

volumes were going to increase significantly with the new service line.

This drove a solution to create a dedicated and secure EDAP unit that includes five secure assessment rooms, private TVs, a patient lounge, consult room, and team center with dedicated support and patient support space. The new unit addresses patients’ short-term acute illnesses and provides assessment capabilities for up to a 24-hour stay, allowing staff to determine whether the patient requires inpatient admission or is ready for discharge.

UNIVERSITY HOSPITALS

Center for Emergency Medicine

Cleveland, OH

University Hospitals Cleveland Medical Center worked with Array to complete a facilities master plan, which illustrated the need for a new Center for Emergency Medicine (CEM) to replace their current outdated and undersized unit. The plan identified the need for separate pediatric and adult treatment areas and an efficient fast-track for non-urgent patients, as well as a crisis unit.

Several concept diagrams were prepared based on defined capacity and operational requirements. The diagrams were used to

develop project parameters attuned to the needs of patients, staff, and hospital leadership.

Array worked closely with the physicians and nursing staff to develop the functional and space programs and to focus on an appropriate design model providing flexibility while supporting the creation of a pediatric emergency department within the CEM. Orderof-magnitude project budgets were developed with the assistance of a team of consultants and a cost estimator, which contributed to an efficient Board approval process.

UNIVERSITY HOSPITALS

Ahuja Medical Center Emergency Department

Beachwood, OH

University Hospitals engaged Array to provide system-wide master planning services to assist with capital prioritization for facility improvements and projects that became known as ‘Vision 2010.” A key component of the Vision 2010 strategy was a new state-ofthe-art suburban hospital.

Cleveland’s eastern suburbs have experienced one of the largest population surges in the nation and, to better serve this growth, Ahuja

Medical Center features a 144-bed, state-ofthe-art hospital designed to accommodate future bed tower expansion (scalable to 600 beds total).

A 22-patient position emergency department was part of the program. It features only private rooms, as well as a dedicated x-ray room and satellite lab to speed diagnoses and reduce the need to transport patients to another area of the hospital.

ST ELIZABETH HEALTHCARE

Freestanding Emergency Department

Covington, KY

Attached to an ambulatory care center, this freestanding emergency department was developed following the closure of an outmoded inpatient hospital and allowed relocation of diagnostic/treatment services in support of the local community.

The facility established an outpatient experience where the patient can be scheduled more conveniently and treated more quickly in a less clinical environment. Array was engaged to create this ‘Gateway for Health’ that would assist St. Elizabeth in raising its profile in this growing demographic. The building, developed by Anchor Health

Properties, was strategically sited for public awareness from a major interstate that fronts the site.

In addition to emergency medicine, related services include imaging, lab, wound care and dialysis are located on the first floor for ease of public access and cross utilization of staff. Also located on the first floor: central registration, community conference space, bistro, gift shop and patient education center. Access to these services was accomplished by the creation of a “Main Street” circulation design that fronts all services.

CAPITAL HEALTH

Hopewell Greenfield Hospital Emergency Department

Pennington, NJ

Array, in association with HKS, designed a new state-of-the-art replacement hospital for Capital Health. Collaborating with Anchor Health Properties (developer & owner’s representative), the design team was tasked with creating a facility that elicits a “Wow, I can’t believe this is a hospital!” response.

The replacement hospital contains a new 28,000 SF emergency department which is located and configured to expand independently of other departments. The

ED contains all universal, private exam rooms with sliding glass break-away doors. There is also an imaging room directly accessible to both the adult and pediatric triage areas.

The team designed a family waiting room to provide positive distraction for families waiting for emergency care. This space is adjacent, yet separate from the general ED waiting area and allows children a safe, enclosed space with right-sized furniture as well as views toward the healing garden and connecting corridor.

ONE BROOKLYN HEALTH

Interfaith and Brookdale Emergency Department Upgrades & Expansions

Brooklyn, NY

Interfaith Medical Center

Array worked with One Brooklyn Health to redesign and expand the emergency department at Interfaith Medical Center in order to address capacity issues and adhere to New York State FGI 2018 guidelines. Based on a study of the department’s ideal future state and efficient workflow, the new plan layout creates two distinct “pods” for vertical and acute care. Each care area includes a dedicated nurse station, and support rooms are located on shared corridors connecting the two pods.

Brookdale Medical Center

The emergency department at Brookdale Medical Center is similarly in need of upgrade and expansion to meet current demand. Array Architects and Array Advisors conducted a feasibility study with One Brooklyn Health to ascertain a path forward for the medical and psychiatric EDs within the facility.

The team facilitated initial discovery meetings to first understand Brookdale’s needs and determine the optimal future state flow of the department. Concurrently, Array Advisors developed a simulation model using a full year of patient

The current emergency department includes a dedicated psychiatric ED, which was relocated to accommodate the department’s expansion. Based upon information gleaned from stakeholder/ user group visioning sessions and community engagement workshops, the new psych ED incorporates a split-flow approach to separate walk-in ED patients from those arriving by ambulance through a secure sally port entrance. The psych ED includes a behavioral health exam room, intake room, four private secure holding rooms, and a patient lounge.

data to determine the optimal number of patient positions based on community need.

With total project cost being a major consideration during the study, the planning and design team worked closely with senior leadership to right-size both the medical and psychiatric departments and determine the appropriate extent of construction. The resulting plan is a combination of cosmetic upgrades and renovations, with a carefully balanced layout that works for both departments and stays within the project budget.

BROOKDALE EMERGENCY DEPARTMENT RENOVATION DIAGRAM

INTERFAITH MEDICAL CENTER EMERGENCY DEPARTMENT

KNOWLEDGE SHARING

Array has built a culture of knowledge sharing that drives innovation and continuous improvement. Our research and public relations initiatives have caught the attention of clients, industry peers, and leading news organizations.

Array in the Press

Contributing to the Conversation in Healthcare Design

The Value of In-Concert Design Planning

by Array Architects President Noah Tolson

Fresh Approach: Planning Pediatric Care in a New Market

by Array Advisors President Jonathan Bykowski

Understanding Integrated Project Delivery from Multiple Industry Lenses

by Array Architects Senior Regional VP and Design Practice Leader, Kent Doss

COVID-19 Resource Hub

Launched as the pandemic was taking hold, this website offers tools, webinars, and case studies to bolster health system response. The America Hospital Association took notice, including our research in their 2021 report.

Master Planning in Today’s Environment

Our master planning approach is catching the attention of industry publications, peers and new clients at a rapid rate.

Discover the value of in-concert design planning in this Healthcare Design article by Array President Noah Tolson.

Behavioral Health: Re-Imagining Care

Thought Leadership Website Spotlight

Exterior Design Feature: Children’s Hospital of the King’s Daughters Mental Health Tower

Designs Delivered: Inspira Health Medical Center Mullica Hill

Explore the light-filled, technologically advanced and thoughtfully-designed replacement hospital that is Inspira Medical Center Mullica Hill.

Blog: Empathy and Experiential Approach to Pediatric Behavioral Health Environments

Discover the key to creating healing and hopeful pediatric behavioral health environments in collaboration with clients and family advisory groups.

Blog: Eliminating Rework by Taking Advantage of Prefabrication

Explore how the Array team closely coordinated prefabrication of the exterior panels that clad Inspira Medical Center Mullica Hill’s 473,000 SF hospital.