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Did you know that 150 million people in the U.S. go to the Emergency Department every year?  That's half the population of the country.

But contrary to popular belief, that number hasn't really increased since the Affordable Care Act took hold. Emergency Department admission rates have gone up just 5% the past few years.

These are just a few of the things I learned at The Center for Health Design's Pebble-in-Practice Workshop on Emergency Department design last week.  Produced in partnership with the American College of Emergency Physicians with sponsorship by HKS, the line-up of speakers was impressive.

Here's a few more things the ED experts had to say that are impacting design:

  • Use of CT scanners is down in emergency departments. MRIs and ultra sounds are up.
  • Freestanding emergency departments, urgent care clinics, and retail clinics are HOT.
  • Volume changes are driving some of the emergency department design and renovation needs, but flow is driving most of them.
  • Behavioral health patients are a burden on many emergency departments. Expect this to change in next three years as more psychiatric virtual care centers emerge.
  • Technology like Amazon Echo will evolve to allow interaction with physicians, hospitalists. Children's Hospital in Boston is already using it.
  • A bigger Emergency Department doesn't fix flow problems. Parkland Hospital in Dallas found this out after it opened its 154 treatment room ED last year.
  • Making spaces warm and friendly can compromise security. Because staff may let their guard down.
  • Split flow Emergency Design, considered by many to be the best solution today, doesn't always work. Flex space is the new trend.
  • Internal waiting rooms for fast track patients eliminate the "they got a table before me" syndrome.
  • Putting public parking under the critical infrastructure of your hospital is not a good idea.
  • Don't design separate areas, like Geriatric Emergency Departments, for one specific purpose. Incorporate the same design features throughout.
  • Identify the storage you need in the planning stage and stick to your guns.
  • No healthcare organization is going to be successful in the future if people have to go find things.

Boldly Go Where No One Else Has Gone Before

I don't expect emergency department design to radically change in the next 5-10 years. Maybe even 20 years.  But a couple of the workshop speakers shared some intriguing ideas.

Jim Lennon of HKS told us about Craig Venter's work on biological teleportation -- the idea of getting DNA sequences over the internet to synthesize proteins, viruses, and even living cells.  You could fill a prescription for insulin, for example. Or get a flu vaccine.

"This is already happening," Lennon said.

Also, diagnostic devices that work with smart phones will also replace some of the equipment used in EDs. "Does the doctor wear them around his belt? Pick them off a cart?" Lennon asked.

What does all this mean for future of emergency department design? John Huddy of Huddy HealthCare Solutions shared his "ED Vision 2080," where human interaction leads and technology supports.

His video simulation of a future ED is a fascinating look into what the future might hold -- like signage tied to your retina code with text specific to only you. Or a "blob bed" that morphs into an exam table. Smart pods that allow you to experience rejuvenating therapies before you go home. And lots more.

(Huddy recently published the second edition of his book, Emergency Department Design: A Practical Guide to Planning for the Future.)

If you missed the ED Workshop this year, don't despair.  The Center for Health Design will probably offer it again next year.

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Leave a comment

Barbara Allen

8 years ago

I heard about an urban healthcare system evaluating mobile triage/ambulances to assess patient condition and if they really did not need emergency care, they could transport patient to an acute care clinic or give transportation vouchers. Patients without acute illnesses or conditions often can get care much faster than if they waited in the ED - and it could help reduce costs. It made sense at the time, but I am sure there are liability issues or other costs that may have prevented implementation.


8 years ago

Emergency Medicine does start in the street.....EMS triage and a complete make-over of the way we triage, treat and transport patients in the field must be part of a comprehensive overhaul of the general Emergency patient care system. Hospital must put the egos on the shelf and cooperate with their EMS delivery systems on a far broader range of options. That being said, the above article has completely ignored the daily surge and overflow in to hallways seen by just about every hospital in the US. The burden of this comes in many forms, including opioid drug abuse, hospital re-admissions, general abuse of the EMS system as a taxi service, and general hospital "throughput" of freeing up in-patient rooms to move admits out of the ER. We have to survive the next 5 years in order to even get to the 10 year down the road mark. It "ain't pretty" and denial by so many in the A & D community that hallway patients even exist does none of our respective clients any service. This opinion coming from a 40 year veteran of the fire EMS service and almost as long serving the A & D community.

Sara Marberry

8 years ago

Thanks for your comments, Gary. Several of the people who presented case studies at the workshop did talk about hallway overflow, so I don't think they are ignoring the problem. Building bigger EDs does not always solve hallway overflow, but many offered ideas for different spaces in which to triage patients.

Dave Willer

8 years ago

Building bigger EDs, and freestanding EDs, does not solve the issues. Recent experience has indicated that even with the rise in freestanding EDs, the pressure is not alleviated on the hospital-based, sponsoring ED. In several institutions that I have studied, the issue of holding patients awaiting admission is a large issue. Processes in the ED and patient discharge processes are frequent challenges.
Experiments in facilities with Results Waiting Rooms, for those patients awaiting test results, are a step in the right direction to get patients out of exam rooms.

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What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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