Utilizing alternative treatment settings to provide efficient, effective and equitable patient care
In an effort to decrease the high volume of patients in the emergency department, increasing construction and promotion of healthcare support facilities are being seen in communities nationwide.
Various models and levels of outpatient care are available, but all models will aid in decreasing the overpopulation of EDs and allowing patients who need emergency care to more readily have access to it.
By providing locations with only the level of care needed to diagnose and treat these patients—and not using an emergency room physician to diagnose the common cold or sprain—these patients can be seen more efficiently, emergency rooms can be utilized more effectively for higher acuity patients and overall healthcare costs will decrease for both patients and providers. Four models of outpatient support facilities include:
Emergency room fast-track spaces
Urgent care centers
Freestanding emergency departments
Each type of model operates differently and features distinct design features geared toward efficient and patient-friendly experiences.
Emergency Room Fast Track Hospitals nationwide have begun to incorporate fast-track areas into existing EDs to separate low-acuity patients from patients with higher levels of illness or injury. By employing this model, EDs can utilize a mid-level provider to treat the patients, decrease the door-to-door time for this subset of the population and increase availability of ED beds for higher-acuity patients.
The design of these areas is very unique and varies greatly from hospital to hospital. These “treat-and-street” areas focus on keeping the patient vertical and out of bed, so interior design elements tend to be very “chair-centric.” By utilizing patient recliners, open bay spaces with minimal square footage and quick access to ancillary services, these patients can be seen and treated quickly in 60-90 minutes. Caution should be taken to ensure these spaces are complaint with HIPAA requirements and maintain patient confidentiality, and surfaces should be very easy to clean and maintain for a quick turnaround between patients.
Primary Care/Outpatient Clinics Outpatient clinics are designed and managed similarly to primary care facilities. Clinics have limited business hours, operate mostly by appointment and provide both non-emergent and preventive treatments.
Clinics tend to be designed with a waiting space that can accommodate patients and families with access to technology (TVs, Wi-Fi access, etc.), child play areas and acoustic privacy. Treatment rooms tend to be small and only accommodate the patient and minimal family members. Forward-thinking clinics employ Lean techniques to ensure patient travel distance is minimized, resources are readily available and intuitively organized; non-value-added steps are eliminated from the patient treatment process.
Urgent Care Urgent care facilities appear almost identical to clinics in building design, but operate much differently for patient care. Appointments are not needed to be seen, so the degree of difficulty to see a physician is much less—a very attractive feature for patients in pain.
Design for urgent care facilities tends to be geared toward both efficiency and patient experience. Typical turnaround time goals for urgent care facilities range between 60-120 minutes, driving the need for fluid design and intuitive layouts. Nurses and healthcare providers must have sight lines to the waiting room and to patient rooms to ensure patient safety is taken into account.
Patient rooms must be appropriately sized for point-of-care testing, as well as include a family zone for patient guests. Design of urgent care clinics must take both adults and children into account as both populations frequent these facilities for diagnosis and treatment.
Freestanding Emergency Departments Freestanding EDs are becoming a mainstream healthcare option nationwide, and widespread growth began to skyrocket about six years ago. According to the California Healthcare Foundation, freestanding EDs are approved for operation in at least 16 states, and 86 percent are affiliated with a hospital or health system.
From a design perspective, freestanding EDs should be modeled along the lines of current hospital EDs. Waiting areas should be generous enough to accommodate patients with families, be pediatric-friendly and include acoustic functions to provide privacy for patient information.
The overall department layout should reflect a one-way patient flow with exam rooms, ancillary functions like X-rays and MRIs, and retail pharmacy options upon check-out. FEDs are located in office parks or shopping centers, so visibility and building design should attract patients and allow ease of access from the surrounding area. Interior finishes should be attractive and high-end but easily cleanable and long-lasting.
Emergency room overcrowding is an alarming issue nationwide, but options exist to alleviate high patient volumes and create space for true emergencies to be diagnosed and treated in hospitals. Emerging healthcare support settings such as ED fast-track areas, outpatient clinics, urgent care centers and FEDs allow patients with lower acuity illnesses and injuries to be seen quickly and treated effectively, thereby decreasing both patient turnaround times and overall healthcare costs. Providing options for patients to get the appropriate level of treatment in easy-to-access locations that are appealing to their schedules will vastly improve their overall experience with modern-day healthcare.
Editor’s Note: Stay tuned for the March/April issue of MCD, which is focused on healthcare support facilities.