Case Study: An Urban Emergency Department’s Journey A Deeper Look An Emergency Department needs to run smoothly and efficiently while being prepared for the unexpected needs of its community. A holistic approach to the ideal future state of the Department and its adjacent services is a vital part of ensuring seamless patient care. Also important is the sense of reassurance the ED environment provides. The tension of traumatic situations can be lessened by implementing efficient workflows and incorporating a comfortable, easily maintainable and safe interiors plan.
Designing for Efficiency CHALLENGE
PROJECT UNDERSTANDING AND CONTEXT Located in New York City, the Veterans Affairs Harbor Healthcare System’s Emergency
A dated Emergency
Department serves a diverse patient base with an array of needs, both physical and psycholog-
Department called for modern-
ical. The need for a welcoming, secure and easy to navigate space to accommodate a growing
ization. Yet upon closer look it became apparent that the space was not just dated but was also inefficiently organized. An increase in walk-in volume raised patient safety concerns as staff struggled with space constraints.
SOLUTION
volume of patients and staff was especially important for the ED’s administration. A feasibility study of the entire Department and its adjacencies was conducted to target specific spaces where staff workflow and patient transitions were faced with obstacles and time delays. The feasibility study showed a need to reorganize the entire ED as well as five adjacent first floor departments (primary care, pre-bed care, admissions/registration, beneficiary travel and medical fee units). The study also concluded that areas throughout the Department were not designated by specific patient needs or services, leaving them overwhelmed by multipurpose use and leading to inefficiency and patients feeling confused and unsafe. In order to maximize efficiency and patient safety, as well as add needed services for veterans, a holistic renovation and expansion
A feasibility study of the ED and surrounding services pinpointed inefficiencies and op-
plan was made a priority. With clinical and administrative input, an intricate and highly-detailed multi-phase construction
portunities for improvement.
plan was devised - allowing the ED (and other affected departments) to remain fully operational
A Department reorganization
during the improvement process. The clinician voice was critical to fully appreciate the census
was in order and subsequently
fluctuations, acuity levels and throughput challenges. The valuable contributions of the adminis-
budgeted in phases to allow full services to continue during construction.
trative team provided the project designers with admission data and procedures - important to understanding the next steps patients and staff may take once the patient condition is stabilized in the ED.
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CURRENT CONDITIONS The ED is located on the first floor and provides care for 15,000 veterans/year. With the renovation and restructuring of the ED, this project will reorganize the entire first floor, placing an emphasis on staff workflows and patient circulation. With no designated ED waiting area, nor areas for women’s or behavioral health services, patients seeking these services felt apprehensive among other patients within the main ED. Having only a common waiting space also caused additional strain on the ED staff. Additionally, staff offices are neither centralized nor convenient to the services they support, creating extra footsteps and less staff-to-patient time. The Travel Unit - responsible for coordinating transportation, and such departments as Admissions/Registration, were inconveniently located far from the hospital’s main public spaces and entrances. Furthermore, inconsistent and confusing signage frustrated veterans looking for their destinations. By looking at the first floor holistically and considering the ED’s adjacent services, it was apparent that certain departments needed to relocate, either because they did not have an active role in an ED or because their location caused disorganized staff/patient flow. With a reorganization of the entire Department, additional space for behavioral health and women’s services can be accommodated conveniently and discreetly. Only by looking at the Department as a whole , and considering its adjacencies was it possible to design a comprehensive modernization solution.
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Implementation
IMPLEMENTATION
NURSE STATIONS
Remaining operational throughout construction was a key
Two new nurse stations will be included in the ED - a new cen-
driver of this phased project delivery. The team worked closely
tral station and a secondary/triage station. The two stations
with ED administration to develop a phased construction plan -
will provide more flexibility for ED staff workflows. During late
including two main phases with multiple sub-phases.
nights and off-peak hours, the triage station and five adjacent
Phase I: The expansion of the ED - includes a new secondary nurse station, five treatment bays, waiting areas, a dedicated entrance with a new lobby and triage, a dedicated behavioral health unit with nurse station and interview rooms as well as an administrative suite with patient waiting area. Once complete, Phase II, the renovation of the existing ED space, will begin and include seven new treatment bays, one isolation treatment bay and a new women’s center with two beds and an OB/GYN exam room. The new full ED will increase patient treatment spaces to 19, allowing patients to move from waiting and triage more quickly into treatment. Finish upgrades, including resilient flooring and walls, a contemporary color scheme and better visibility are included in the plan to completely modernize this
treatment areas can function as the primary ED. During busy and patient overflow times, it can function as a Fast-Track area, and the central station will support the main ED space. Patient flow will be enhanced with the central nurse station relocated to the center of the Department’s racetrack design. The design allows more clinicians to utilize the space for a variety of tasks and brings necessary support and supplies close-by. TREATMENT BAYS AND OBSERVATION UNITS The increase in number of treatment bays is needed to meet demand as well as comply with code requirements. Sliding glass doors with cubicle curtains will enhance patient privacy and aid in infection control measures.
busy Department . PAGE 4 | case study: transforming the ED journey
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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.
WOMEN’S CENTER Without a designated Women’s Center, female patients receiving treatment at this campus feel their health needs are not being met and their safety compromised. The new two-bed Women’s Center was designed to enhance privacy with an attached OB/GYN Exam Room and dedicated patient toilet / shower room. Also included are urgent-care behavioral health services. SUPPORT AREAS
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.. 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.
Renovations to the support areas include increased practicality in the medication room with additional work surface and storage space. The clean and soiled utility rooms will be relocated and expanded to improve functionality and to comply with VA requirements as well as to accommodate new equipment. A new staff lounge, lockers, toilet/shower and on-call room will be added.
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