Is Acute Outpatient Care The Future of Emergency Department Design?

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What's happening in emergency department design?

I wanted to know, so I went to The Center for Health Design's "Emergency Department Workshop: Considerations for Innovation and Strategic Design" this week. The roster of speakers was a "who's who" in emergency department operations, planning, and design.

Martin Lucenti, M.D., Ph.D., an ED and Army combat support hospital doc, now a Senior Principal with Vizient said that he believes emergency medicine and the configuration of emergency departments in the U.S. is about to really change.

"Inpatient volumes will start to go down," he said. "Acute outpatient care settings are the next wave."

For now, despite all the changes in the U.S. health system, the growth curve is still going up, according to data presented by James Augustine, M.D., FACEP, Clinical Professor, Department of Emergency Medicine at Wright State University. "We've had a flat 2.5% growth rate since 1992," he said.

Ground Hog Day

The age-old problem of predicting volume continues to be the challenge.

Frank Zilm, D.Arch., FAIA, FACHA, Chester Dean Lecturer, University of Kansas School of Architecture, Design, and Planning advised workshop attendees to look at four things: 1) seasonality, 2) days of the week, 3) arrivals by time of day, and 4) forecasts for number of visits. He showed a slide with some of those same ideas that were put forth in 1969. "It's like the movie 'Groundhog Day,'" he said. "We keep going through the same issues."

Lucenti believes many providers are trying to solve the wrong problem in the ED. "The problem is not how to respond without enough [beds, space for patients]," he said. "It's how can I consistently have enough?" He also believes that most EDs are "horribly managed from an operational perspective."

GP by the ED?

Workshop Moderator Jon Huddy, AIA, NCARB, M.Arch., BA Design, President Huddy Healthcare Solutions thinks that the future might be adding general practitioner offices adjacent to the ED, which is already being done in the Netherlands. This allows more careful screening and routing of patients. "The old-fashioned hit triage and be bounced back out to waiting is going away," he said.

So how do EDs get to the point where they never have to deliver care in the hallway?

James Lennon, AIA, Design Team Leader for HKS Team ED, presented several case studies that offered some ideas. For example, not all patients need to be in a bed; some can be in a chair. "Results waiting" areas can be designed to be an upgrade to a bed.

At New York Presbyterian Hospital, HKS designed a results waiting area as 40 sq. ft. pods with recliners, exam lights, iPads, privacy glass, acoustical properties, and dimmable lights. "This is cheap, readily available technology," Lennon said.

About the Workshop

This Pebble-in-Practice workshop was produced by The Center for Health Design and the American College of Emergency Physicians with sponsorship from Huddy ED Design, Steelcase Health, HKS, and Kwalu.

I was only able to attend part of the first day, but attendees got the chance to put their learning into practice by working together to program a mock ED.

Tours were also offered of Edward-Elmhurst Hospital's new ED, billed as "the most amazing ED in the world?" It was also presented as a case study on the second day of the workshop.

If you missed this ED workshop, there's a good chance The Center for Health Design will offer it again the same time, same place next year. The next Pebble-in-Practice Workshop on September 26 explores behavioral health design.

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