Emergency Departments ARRAY-ARCHITECTS.COM
Table of Contents Firm Profile......................................................................... 4 Emergency Department Expertise............... 6 RWJBarnabas.................................................................10 Capital Health................................................................12 University Hospitals................................................18 Cooper University Hospital...............................30 Veterans Affairs Medical Center..................36 Ohio State University.............................................44 St. Elizabeth Healthcare......................................48
Firm Profile 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. Our devotion to a healthcare-exclusive The complex, changing world of healthcare requires a team of effective communicators and true collaborators. Our 30-year history of being dedicated to healthcare holds countless stories of exploration and innovation with our clients. Our core mission is the same as that of our clients, improve the quality of our work, increase our efficiency, and motivate our staff to reach for success.
EMERGENCY DEPARTMENT RAPID LEAN DESIGN EVENTS We utilize Process-Led Lean Design methods and simulation modeling to improve throughput and operations within the ED. This allows us to identify and resolve the root cause of long waits within an ED, which results in delivering best practices and patient satisfaction. Array Architects conducts Rapid Lean Design Events for clients who need to quickly assess their current state, identify process improvements and work toward an ideal future state. The case study below details a recent Rapid Lean Design Event and documents how we collaborated with a client to minimize the need for a costly renovation by designing the process first. CLICK ON THE BELOW IMAGE TO VIEW CASE STUDY.
Emergency Departments Expertise Emergency medicine is highly visible and a rapidly evolving medical field. The challenges of emergency medicine include a growing volume and shrinking healthcare capacity. Hospitals view the emergency department as the “front door” to the hospital with over 50% of admissions coming through the ED. Consequently, hospitals have increasingly focused on patient satisfactions 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 needs to be able to respond quickly to an uptick in seasonal flu outbreaks and other, more critical infections that can quickly fill an ED waiting room.
VIEW ADDITONAL ED RAPID LEAN DESIGN EVENTS BY CLICKING ON THE IMAGES BELOW:
Emergency Departments
Emergency Departments are often what patients experience first and remember most when evaluating return for future use.
Dennis Robert, AIA Principal & Studio Director
RWJBarnabas
Ambulance Entrance Reconfiguration New Brunswick, NJ
As part of its modernization and service line expansion strategy to provide additional capacity, Robert Wood Johnson University Hospital needed to improve frontend flow in their Emergency Department (ED), relieve overcrowding, expand & modernize their ambulatory facilities—and maintain a cohesive exterior design in the process. Reconfigured ambulance parking and an 8,100 SF addition affecting both their ED and ambulatory care center, including a new ED walk-in entrance, expanded surgery waiting area, ED waiting area, and shell space for a 21-bed observation unit help to provide additional capacity, improve flow and relieve overcrowding. This project also involved connecting two structurally independent buildings and an existing freestanding bridge directly over a sub grade parking deck. Phasing and logistics for this project were closely tied to, and coordinated with, another Array project on campus, occurring concurrently on the opposite side of the same campus. Both projects took an overbuild approach, a strategic decision for this landlocked campus.
Nurse Station / Treatment Rooms Photography: Blake Marvin
Capital Health
Emergency Department Pennington, NJ
Array Architects, in association with HKS, Inc., designed a new state-of-the-art 237-bed Replacement Hospital for Capital Health. Collaborating with Anchor Health Properties (Developer and Owner’s Representative), the design team was tasked with designing a facility that elicits a “Wow, I can’t believe this is a hospital!” 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.
Nurse Station / Treatment Rooms Photography: Blake Marvin
Left: ED Registration Center: Nurse Station Photography: Blake Marvin Collaborators: AKF Engineering HKS, Inc. O’Donnell & Naccarato Skanska Target Building Construction The Lighting Practice Van Note-Harvey Associates Wells Appel
“The efficiency of the emergency department comes from the layout of the nurse station. The nurses have visual contact of all the patient rooms, whether it be a pediatric or adult patient room.” Marsha Whitt, CHID, EDAC, NCIDQ, Lean Six Sigma Healthcare Principal and Regional Vice President, Southwest Region
Healing Environments
“Environments have the power to set our expectations, lift our spirits and inspire hope. This is what motivates me to create spaces that mitigate the challenges faced by all who enter a healthcare facility.� Patricia D. Malick, CHID, EDAC, NCIDQ, Lean Green Belt Principal and Practice Leader, Interior Design
University Hospitals Case Medical Center Center for Emergency Medicine Cleveland, OH University Hospitals Case Medical Center completed a Facilities Master Plan (provided by Array) which illustrated the need for a new Center for Emergency Medicine (CEM) to replace their existing 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. Several concept diagrams were prepared based on defined capacity and operational requirements. The diagrams were used to discuss and define parameters to yield development of a project which would best meet the needs of patients, staff and hospital leadership. Site concepts were explored to provide clarity of walkin entrance and associated structured parking, discreet ambulance access with weather protected discharge, and options for discreet behavioral health patient access. 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 ED within the CEM. Order-of-magnitude project budgets were developed with the assistance of a team of consultants and a cost estimator. This planning effort led to Board approval to proceed with the CEM and Parking Garage architectural development and construction documentation.
Pediatric Exam Room Photography: Kevin Reeves
Above: Nurse Station Below Right: Reception / Waiting Center: Pediatric Exam Room Below Center: Trauma Room Photography: Kevin Reeves Collaborators: Cannon Design
Planning
“After having the privilege of working with heroes who cure, treat and receive care in our cancer environments, I will never underestimate the importance of creating uplifting, inspiring cancer spaces.�
Lisa N. Lipschutz, AIA, ACHA, EDAC, Lean Green Belt Principal and Senior Planner
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-of-the-art suburban hospital. Cleveland’s eastern suburbs have experienced one of the largest population surges in the nation. To accommodate this growth, Ahuja Medical Center features a 144-bed stateof-the-art hospital designed to accommodate future bed towers (scalable to 600). As part of the program, a 22-patient position Emergency Department was included, featuring all private rooms. The ED also features a dedicated x-ray room and satellite lab to speed diagnoses and reduce the need to transport patients to another area of the hospital.
Nurse Station Photography: Scott Pease
Top Left: Reception / Waiting Bottom Left: Exam Room Right: From Entrance Photography: Scott Pease Collaborators: CCRD Partners HKS, Inc. Gilbane Building Company MCM Company
Planning
“I actually go into every project with the primary goal of building less, and if we can avoid it, building anything at all. It is my responsibility to help our clients think critically about each move.�
Noah Tolson, AIA, LEED AP BD+C, Lean Green Belt Principal and Practice Leader, Planning
Cooper University Hospital Clinical Decision Unit Camden, NJ
After opening their new bed tower, Cooper recognized the need for additional space within their Emergency Department to improve patient satisfaction and increase throughput. Within very tight site constraints, we designed a 20-bed Clinical Decision Unit to support the bustling, Trauma 1 Emergency Department. The CDU features patient observation rooms, an open nurse station and staff work areas positioned to provide maximum visibility into each room, while maintaining ongoing operations within the Emergency Department. Seamlessly integrated with the existing ED, the CDU improved patient and clinical flow, resulting in reduced Length of Stay and increased patient satisfaction. In order to accommodate office and meeting space for 25 faculty and a rotating group of residents and interns, Array also designed a bistro area into administrative offices for the Emergency Department. The space, with large configurable conference space also allows the Hospital additional meeting space flexibility.
Nurse Station / Private Observation Rooms Photography: Jeffrey Totaro
Above Left: ED Floor Plan Center Left: Nurse Station Center : Observation Room Center Right: Nurse Station Below Right: Observation Room Photography: Jeffrey Totaro Collaborators: Hunter Roberts Construction The Procz Group
Creating Environments
We begin each project with the goal of improving the healthcare experience by aligning the voice of the customer with a sustainable operational model...the projects that we have “on the boards� are illustrations of the progression from broad concepts to physical realities. Kent L. Doss, AIA, LEED AP BD+C, Lean Six Sigma Black Belt Principal and Regional Vice President, Mid-Atlantic Region
Veterans Affairs Medical Center Emergency Department Wilkes Barre, PA
The project provides renovations in Building 1 for the Emergency Department design and program for the WilkesBarre VAMC in Wilkes-Barre, Pennsylvania. The mission is to provide state-of-the-art, high quality treatment services for unscheduled services for veterans as walk-ins and Ambulance arrivals as well as augmenting service needs. The project is currently in phased construction to permit the Emergency Department to remain operational throughout renovation. Renovation also includes the replacement of air handling units on the third floor and test fit studies for best possible locations of the Emergency Department.
Emergency Department Entrance Rendering: Array Architects
The department’s expansion plans were phased so bed counts and staffing levels are maintained during construction and will increase after the first construction phase. This will help the VA reduce their veteran waiting times in the first phase, in an undersized department during the construction project. The waiting room is now subdivided between infectious and noninfectious patients. This unique solution offers fewer chances for veterans to acquire infections and relieves veterans’ stress during visits.
"The ability of Array’s team to interact with our stakeholders and project team was most appreciated. They worked patiently, professionally and diligently with us to make all changes and adjustments as smooth as possible. At each step of the project, the work was performed and presented in a very professional manner." -Robert Calarco, Interdisciplinary Engineer Veterans Affairs Medical Center, Wilkes Barre, PA
Above Left: Nurse Station Above Right: Exam Room Left: Nurse Station Renderings: Array Architects Collaborators: Apogee Consulting Group Bray Mooney Consulting Colden Corporation Harrington Group Mabbett Associates Senate Builders Spotts, Stevens, McCoy WZG Structural Consulting Engineers
This ED project is a part of a larger campus effort to upgrade the VA facility. Learn more about our campus improvement projects by clicking the image below.
Clinical Transformation
“I’m excited by the shift in healthcare towards performance based metrics and patient satisfaction. It’s focusing the value proposition on the patient and family, which I believe will result in higher-quality buildings that will stand the test of time.” Dan Russell, AIA, LEED AP, Lean Practitioner Principal & Healthcare Planner
Veterans Affairs Medical Center Emergency Department New York, NY
Array understands the mission as well as the challenges facing today’s Federal facilities. The VA is charged with offering a range of services that rival the best private and research-based institutions, to our nation’s Veterans and their families. We have an in-depth understanding of the processes utilized on VA projects. As part of the Indefinite Delivery / Indefinite Quantity Contract with the VA Veterans Integrated Network 3, Array has worked on multiple projects at the VA Manhattan Medical Center. It is the only VAMC facility to have both a designated Clinical Care Unit and Research Center for AIDS and HIV Infection (RCAHI).
Top: Waiting & Registration Bottom: Nurse Station Renderings: Array Architects Collaborators: Accu-Cost Construction Consultants Goldstein Associates Consulting Engineers Kallen & Lemelson Shen Milsom & Wilke
The project goal is to re-plan, renovate, and expand the Emergency Department in order to enhance work flow and efficiency of the Department. The 7,000 SF ED will expand to 13,000 SF to include new ED Access, Waiting, Triage, Nurse Station, Treatment spaces, Administrative offices and a Psych-specific ED area. A new rooftop Air Handling Unit will be provided, specifically dedicated to the ED. The scope of work also involves relocating the Eligibility / In-Take area into the Medical Center’s atrium space, renovating a portion of the Atrium, providing a new Primary Care Reception and Screening Area and a new Travel Unit, as well as relocating the Medical Fee Unit, Pre Bed Care and some Primary Care treatment rooms. The upgrades will improve patient throughput, as well as address the ED master plan for the future. Intricate Phasing of the project will take place while keeping the ED and surrounding areas in operation. Chief of ED is aiming for a “benchmark” ED.
Ohio State University Clinical Decision Unit Columbus, OH
The 670-bed academic medical center has more than 1.6 M SF across four buildings—several of which date back more than 50 years. To accommodate the Medical Center’s constant growth and provide patients with the latest advances in technological innovation and development, OSU retained Array for development a Clinical Decision Unit. The Clinical Decision Unit was designed to accommodate the influx of patients seeking emergency medicine as their first contact with the Medical Center, the Clinical Decision Unit is a 6,562 SF expansion of the current Emergency Department. The program presents the Medical Center with 22 additional private treatment rooms supported by expanded nursing. The proximity of the CDU improves Emergency Department performance by accommodating patient observation away from more fast-track-oriented treatment bays.
Top: CDU Bottom Left: Nurse Station Bottom Right: ED Corridor Photographer: Scott Pease
Collaborators: Korda / Nemeth Engineering The Osbourne Engineering Company
Patient Experience
“I knew I wanted to do something meaningful and powerful with my skill set. Healthcare design was a natural choice.�
Jennifer Tinsley, NCIDQ Interior Designer
St. Elizabeth Healthcare Emergency Department Covington, KY
This new, three-story full-service Ambulatory and Emergency Department was developed as a result of the need to close an outmoded inpatient hospital and allowed relocation of diagnostic / treatment services in support of the local northern Kentucky community. The facility establishes an outpatient experience where the patient can be scheduled more conveniently and treated more quickly in a less clinical environment. Array was engaged as architect to create a ‘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. Ambulatory Care services including emergency services, 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 are a central registration / reception desk for the entire building, community conference space, a 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.
ED Walk-In Entrance Photography: J. Miles Wolf
Above: ED Exam Rooms Below Right: ED Team Center Below: Reception / Waiting Photography: J. Miles Wolf
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