The design and construction of hospital Emergency Departments (EDs) have evolved significantly over the past few decades, driven by technological advancements and evolving healthcare delivery models. With many existing EDs needing upgrades to address today’s challenges, architects and builders must consider various factors to create both efficient and adaptable spaces to future needs.
Design Considerations
Staff and Patient Flow Optimization
Modifications to existing departments should facilitate smooth patient flow from arrival to discharge. In many facilities, we are now implementing a “split-flow” model, which separates patients by acuity levels:
- Fast-track, first look, or vertical care areas for minor injuries and illnesses. These areas are often close to the entrance and discharge areas, so patients do not have to enter the critical areas of the main ED
- Critical care zones for high-acuity patients, including direct ambulance access, trauma, and significant dedicated radiology services
- Results-pending areas where patients can wait comfortably for test results
Addressing Volume Growth
Planning for future growth is critical to addressing ED modifications and must consider the following:
- Projected patient volumes
- The average length of stay
- Peak hour statistics
- Seasonal usage patterns
- Population growth projections
Treatment rooms (typically 120-150 SF) can be enlarged where feasible to accommodate family members and modern medical equipment.
Flexibility, Adaptability, and Design Ideas
Treatment rooms are increasingly designed to be universal, allowing for various types of care in the same space. Multiple entrances can be isolated to control the types of patients entering to avoid contamination of more significant areas of an ED. This adaptability helps EDs manage surge capacity during mass casualty events or pandemic situations. In addition, other design ideas we’ve implemented include:
- Sound-absorbing materials to decrease noise levels
- Decentralized nursing stations to improve patient monitoring
- Private rooms to enhance infection control and patient privacy
Technology Integration
As healthcare technology continues to become an integral part of care, we consider incorporating:
- Advanced imaging equipment
- Patient education systems
- Electronic health record systems
- Telemedicine capabilities
- Point-of-care testing devices
Construction Considerations
Elements to keep in mind related to renovating existing ED’s include:
Planning for construction
For our current major ED renovations, we apply advanced technology to assist in design support to help minimize the impact on current operations. Some of these technologies include:
- Using mobile laser scanning to accurately confirm the location of major structural elements of the building.
- Working with the architect to ensure their plans reflected these locations to avoid layout problems in the field
- Referring to detailed 3D modeling for phasing and sub-phasing to minimize clinical disruption
- Using real-time animation software for site logistics planning to identify and minimize impact on ambulance and walk-in traffic and work with the communications team to advise the public
Security Concerns
Rising concerns about workplace violence and the need to mitigate external threats from entering the ED have led to enhanced security features, including:
- Controlled access points and some with metal detectors
- Multiple escape routes from treatment rooms
- Strategically placed security stations
- Video monitoring systems
Safety Concerns
Care must be taken in an active hospital setting to ensure patient, family, and provider safety. For example, in Gilbane’s expansion project for Inova Fairfax’s ED, the building’s addition and renovation are within a populated, active hospital. Robust and redundant efforts are in place to maintain infection control barriers, patient and staff safety, and the protection of all construction personnel. These include:
- Infection control, including negative air pressure zones, HEPA filtration, and temporary barriers
- Noise/vibration mitigation, including off-peak scheduling, noise-reducing equipment, and vibration monitoring
- Hazardous material management with proper handling/disposal and abatement procedures
- Infection prevention training for construction workers
Building and SMART Technologies
We are also trending towards incorporating sustainable and efficient building practices:
- Natural lighting to reduce staff fatigue and improve patient outcomes
- Modular construction techniques for faster building and potential reconfiguration
- Smart technology for patient tracking and resource management
- Energy-efficient lighting and HVAC systems
- Sustainable materials
Conclusion
Renovating an existing ED is a significant undertaking for any healthcare organization. It must balance multiple priorities, including patient experience, staff efficiency, technological integration, and minimal disruption from construction methods. Adapting existing spaces while maintaining ongoing operations requires close collaboration between architects, clinical staff, administrators, and contractors, but spaces must be created that meet both current demands and future challenges. By carefully considering patient and staff workflow and emerging construction trends, hospitals can renovate emergency departments that will serve their communities effectively for years to come.
