Case Study: A New Direction for Treatment A Deeper Look An ideal patient treatment space must be rightsized, appropriately zoned and safe. We apply the tenets of evidence-based design and patient and family-centered care to every aspect of our room configurations - from non-urgent ED care to inpatient at every acuity. We lead in-depth focus groups and mock-up sessions with caregivers, patients and their families to ensure the ultimate solution reflects the mission, values and vision of all constituents. The hallmarks of success are improved outcomes, reduced injuries & infections s well as stellar patient satisfaction scores, which influence Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and engender patient loyalty.
Vertical Treatment Space EMERGENCY SERVICES RENOVATIONS
PROJECT UNDERSTANDING
CHALLENGE
increase patient throughput. A fundamental component of this initiative is the revitalization
With an Emergency Department which sees 45,000 patients per year, Lancaster General Hospital needed a solution to quickly expedite the way they triage and treat low acuity patients.
SOLUTION
PennMedicine Lancaster General Health’s (LGH) flagship hospital needed a solution to of the Emergency Department (ED). With just under 1,300 SF available for this improvement effort, space in the ED was limited. Resourceful staff found creative ways to utilize what little extra space was available to them for a variety of purposes. The lack of available space for growth was among the main reasons LGH chose to use vertical treatment bays for their less emergent patients. Research shows that using a vertical treatment space, rather than having a patient horizontal, is beneficial to the patient in numerous ways. The desired project scope included high-impact cosmetic upgrades, including finish materials, lighting and millwork; mechanical upgrades; safety and regulatory upgrades; and, associated reconfiguration and construction. PLANNING STUDY
Lancaster General Hospital maximized treatment space and improved patient discharge time by creating five dedicated vertical treatment bays.
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During the Certificate of Need process, Array recommended LGH increase their original number of vertical treatment bays from three to five to fully maximize the space. This configuration allows four open and one private bay, which can also serve as a consultation room. By mapping the patient experience from check-in to discharge, as well as mocking up the space to the right-sized room, Array was able to gain a deeper understanding of how staff intended to use the space. This helped to plan the correct room size.
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Improve the patient experience and outcomes through the environment
HOW IS A VERTICAL TREATMENT SPACE BENEFICIAL?
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Utilizes less space
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Low-level acuity patients can be treated more quickly
WHY CHOOSE A VERTICAL TREATMENT SPACE? With an ED which treats 45,000 patients/year in small exam rooms, LGH knew that to accommodate an increased patient volume the ED needed to expedite the way they see patients. Creating a vertical treatment space enables staff to bring the lowlevel acuity patients into a separate waiting area. This provides patients with more access to staff. If the patients need labs or imaging, they come and go directly to and from this area. Vertical treatment also made sense for this project because it utilizes
•
Not for inpatient/overnight use
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Staff can assist a larger patient volume
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Patients’ pain level is lower
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Operationally efficient
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Patients are more comfortable
less space, as a recliner has a smaller footprint compared to a stretcher. CODE REQUIREMENTS
“To successfully create space
With the benefits came some challenges. Code requirements have changed
to fast-track ED patients from a
since the facility was built, so all planned renovations needed to bring the space
tight footprint was a challenge
up to current code. In particular, the ratio for toilet rooms per number of beds had increased but the available space did not allow for code compliance. To ensure the
that brought the whole team
correct number of toilets per bed, LGH decided to decrease the size of a consultation
together with a driving
room to create space for an additional toilet room. The team found the code did not directly address treatment bays, which exist in the undefined gray area between triage space and treatment room. Working closely
common goal. The ability to help Lancaster achieve better
with a code reviewer, the team ensured the project’s scope was understood and the
throughput for their emergent
code interpreted correctly. Ultimately, the vertical ED bays are required to meet a
patients is rewarding, and we
treatment room level of design until the code is revised to address this emerging healthcare solution.
hope it leads to an increase in
A thorough code review of the ED confirmed LGH was allowed five vertical treatment
satisfaction scores as more
bays. However, since the bays are considered beds by code, handwashing stations
patients are treated swiftly and
needed to be accommodated in the design with one station per four bays. The area
conveniently.”
selected for renovation was equipped with two sinks, but one was considered a nourishment station because it had an icemaker. Since nourishment stations are
- Nicole Wood, Engagement Manager
required to have a sink, and cross-contamination was to be avoided, room for a single sink within one of the treatment bays was identified.
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Collaboration
CURRENT AND FUTURE STATE Prior to conducting a current state analysis, LGH provided Array with the approved business case for the project. It outlined the patient criteria for the treatment bays and included a rough idea of their ideal future state process. Array’s team worked with a multidisciplinary LGH group to map the current state process and review the Department’s ideal future state process. By observing their current intake and throughput processes as well as identifying improvement opportunities, our lean-led design team ensured the design would function optimally for the ED staff. MOCK-UP In order to right-size the vertical treatment bays, the team created a physical mock-up. To give the user group an accurate portrayal of how the space would feel and function, cardboard was used to outline the wall locations. All main fixtures - the patient recliner, a guest chair and a rolling cart with drawers and writing surface - were included in the mocked-up space. It gave clinicians the opportunity to move furniture around to find the best configuration. Initially, staff envisioned the recliner in the corner to give them the most room, but realized some staff would need to reach over the patient to access medical gases. As they arranged and rearranged the mock-up space, it helped the group realize how the layout would affect each of them individually and come to a consensus which addressed each of their concerns.
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Who We Are ARRAY-ARCHITECTS.COM
We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most. This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning decades.
Vertical Emergency Department Bays
Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.
Array’s Knowledge Communities We believe strongly in sharing our expertise and knowledge with others. We invite you to explore each of our thought leaders and share your thoughts with the healthcare design community. Click here to visit our Thoughts page.
Click here
to view our thought leadership on emergency departments
Private Vertical Emergency Department Bay
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Published: October 2020
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