‘The Wait is Over’ for Emergency Department Patients at St. Elizabeth Hospital

By Scott Lindvall

In today’s emergency departments, the challenges are complex. The need for immediate patient care must co-exist with staff efficiency, space restrictions, accessibility to equipment, complicated treatment protocols and the bottom line. This has resulted in long patient waits and, consequently, customer dissatisfaction. At St. Elizabeth Hospital in Appleton, Wis., however, “The wait is over,” as the organization’s President Travis Andersen is fond of saying.

The hospital’s new no-wait emergency department and surgery procedure area is the result of an innovative design process. As part of the Affinity Health System, St. Elizabeth sees its commitment as a wheel, with personalized patient care at the center. So when it came time to re-envision its ED, St. Elizabeth’s administrators, staff and architectural team initiated a process that began with feedback from 400 patients and staff.

Overall, St. Elizabeth’s customers articulated 73 areas for improvement — including a new ED entry area with immediate accessibility. This critical feedback was then integrated with a renewed cultural commitment to patient-centered care, and proven strategies from the fields of Evidence-Based, sustainable and Lean operations and design.

The integrated design process eliminated excess waste from multiple sectors: unnecessary construction materials, underutilized space and excess energy use; patient waiting, processing and room transfer; staff inefficiencies and supply locations. The result is a highly efficient, no-wait ED/SPA that can serve 60,000 people a year in highly clean, quiet, healthy and private spaces.

With a new entrance off a main thoroughfare, the ED/SPA was constructed inside the existing hospital. The new ED/SPA area now includes 47 major-trauma, surgery-and-procedure and flex rooms clustered in “U”-shaped work cells. The centrally located flex rooms serve both the ED and SPA, which have peak hours of operation at different times of day: SPA in the week-day mornings and ED in the evenings and weekends.

Both departments are based on a universal care center, which is designed to cater to patients and family members that will have less than 24-hour stays. Operational efficiencies allow SPA patients and family members to “own” private outpatient preparation and recovery rooms throughout visits.

St. Elizabeth Hospital has minimal ED and SPA waiting areas. Incoming patients are immediately shown to one of the private rooms, each of which has a frosted-glass sliding door. The rooms are identical in layout and location of supplies, which dramatically increases staff efficiency. Patient comfort is maximized through stress-reducing lighting and radiant-heat panels over the bed. The nature-inspired wall murals are created on sound-absorbing materials, greatly reducing noise. In each room, electronic information boards provide staff with constant status updates on every patient’s location and health needs. These changes have helped St. Elizabeth Hospital take “likelihood to recommend” scores to over 90 percent.

Today St. Elizabeth Hospital is utilizing increased efficiencies realized through Lean and Evidence-Based Design to deliver patient care that sets new standards for personalized care delivery. The sustainably designed ED also incorporates state-of-the-art hygienic and natural materials that diverted more than 500 tons of construction debris from landfills. The building also reduces traditional energy use by 25 percent. Through extensive research and analysis, patient feedback, integrated design processes and detailed planning, St. Elizabeth has innovated an ED/SPA that can serve as a template for other hospitals striving to become the best.

Scott Lindvall, AIA, is vice president and healthcare principal of HGA Architects and Engineers.