Design of the Academic Emergency Department

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

“…In fact, nurses and physicians might not deem this strategy to be needed in their own EDs, as most have an established patient and staff flow. Although this finding was not in line with the literature on the importance of one-way patient flows (Halpern et al, 2012;Huddy, 2016;Marshall et al, 2020), our results could have been very different had we collected these data following the COVID-19 pandemic. A one-way patient flow could have provided opportunities for improved patient throughput while reducing infection hazards during the recent pandemic.…”

“…Gil et al (2020) found that locating a dedicated MRI scanner in ED enables faster hip fracture diagnosis and surgical consultation without also increasing ED throughput time. Although including dedicated MRI capability within the ED is not common at this time, Marshall et al (2020) suggest that plans for the addition of this service to the department should be addressed during the design. Imaging within the ED was also considered optimal in the study by Pati et al (2014).…”

“…While several studies have highlighted the importance of flexibility in ED design (Gharaveis et al, 2018), some have suggested practical strategies to enable adaption to significant changes in care demand, including adding a rapid-assessment zone that could add additional acute bed space during volume surges (Anderson et al, 2020); provision of dual headwalls in treatment spaces to accommodate two patients when needed (Marshall et al, 2020); hardwiring patient rooms for the highest level of acuity to enable acuity adaptability (Pati et al, 2014); and, when census exceeds capacity, providing opportunities for adding an intake area with a physician-led triage team (Welch, 2012). In implementing these strategies, like the proposed approaches in this work, the pros and cons of making the investment must be considered based on the organizational and spatial structure of the ED.…”

Adapting to Change: A Systematic Literature Review of Environmental Flexibility in Emergency Departments

“…In the event of a surge in volume, it is important for single private rooms to be sufficiently spacious to accommodate two patients (Holmdahl & Lanbeck, 2013). These rooms should be equipped with either headwall capacity for two patients (Marshall et al, 2020; Zilm et al, 2008) or dual ceiling-mounted booms (Zilm et al, 2008). Another strategy is to create a flexible care area divided by curtains, so when the curtains are removed, the care area can be used more efficiently and more patients can occupy the same space (Halpern et al, 2012).…”

“…In designing EDs, several programming requirements are considered, including expected patient volume and type, available diagnostic equipment, medical technologies, staffing, and workflow (Marshall et al, 2020). However, these requirements are subject to constant changes caused by several factors, including seasonal disease trends (e.g., Fogerty et al, 2019), the emergence of new technologies (e.g., Carthey et al, 2011), and surges resulting from local or global disasters, such as mass casualty incidents (e.g., Valipoor et al, 2020) or pandemics (e.g., Holmdahl & Lanbeck, 2013).…”