An emergency department is often a patient’s first contact with a hospital, so a facility with efficient operations, good patient flow and a design that prioritizes a patient’s comfort speaks volumes.
As such, the ED is one of the most important parts of a hospital in terms of patient experience, making it a focus area for leaders looking to improve operations
and enhance patient satisfaction. To make that kind of first impression, leaders are willing to invest in streamlining ED operations and can implement key strategies to achieve their goals, which can include minimizing door-to-doctor time, optimizing turnaround time on any ordered diagnostics, as well as minimizing overall patient visit time in the ED.
With ED planning, every facility is unique: no prototype or static solution exists. The process starts with operations analysis as leaders analyze the current state of care delivery and develop an appropriate strategy that addresses current needs and future projections. Facility managers offer invaluable insight into operational costs, as well as MEP infrastructure capabilities—especially whether future plans can be served with existing capacity. At the same time, contractors provide budget support for weighing various options.
Depending on the size of the ED, as well as current and projected numbers of patients and staff, some strategies may work better than others. That strategy then informs the creation of a master plan, followed by a physical response in the form of design and construction. The following are key insights to advance your ED.
Studying opportunity
Align. The first and most important step of turning buy-in and ownership into something tangible is for hospitals/healthcare systems to examine their overall direction and strategic initiatives to ensure the future focus is in alignment with their strategic plans, which can include enhancing patient experience and satisfaction, reducing overall visit time and/or delivering care efficiently with fewer full-time employees.
One example project in Florida performed an assessment of all their departments ahead of a new project and implemented a “pivot” in their overall strategy that puts more focus on the patient. They reworked their core values so that all are patient-focused, informing the way they look at care, and then designed their facility to support that approach. Patient-focused core values aim toward delivering optimal patient satisfaction. This means offering intuitive wayfinding in parking areas where plenty of parking is incorporated close to a covered facility entrance, providing a clear registration and check-in process, limiting waiting time and getting patients to caregivers while quickly and effectively turning around any necessary diagnostics, as well as presenting patients with clear discharge instructions upon departure.
Quantify data + input. With financials and market share as priorities, quantifiable data forms the foundation of the project. Such data includes population growth, metrics for ED visits per segment of population and what the ED’s current market share includes, as well as how to optimize that market share. Once the data is gathered, input from staff in all areas helps define smooth operational flows. Involving physicians, nursing staff, board members and others ensures a diverse cross-section of the facility’s culture that often reveals the challenges to overcome for optimal function.
Operationalize the solution. Every service line has a different operations model, all of which are important to operational planning. Once a strategy has been chosen and planned, staff can begin to hone details, such as care model and staffing patterns, during the months between design completion and the actual construction/occupancy, so that their operational patterns are well established by the time they take possession.
Factor budget conditions. Project teams define priorities—people, spaces, instrumentation, IT, etc., overlaying budget conditions in a realistic manner. Good project budget planning accounts for the costs beyond building materials and equipment. These costs include recruitment for the service line amidst market competition and new technology, which comprises an ever-larger part of the budget as it becomes more essential.
Integrating ED + electronic medical records. As technology continues to streamline operations throughout the hospital, it takes a more prominent role in planning and strategy. A key consideration is how to handle EMRs and other documentation, which may be embedded in different systems throughout the hospital. It is best to designate someone from the stakeholder’s leadership who understands and has ownership of this piece of the project.
That leader can ascertain the status of medical record keeping at the beginning of project planning so the ED can comply with initiatives to transition from one system to another, as well as with information security protocols.
Rollout. Many hospitals prefer to bundle multiple changes together, while others opt to get all the EMRs and documentation technology in place before beginning construction. Choosing which approach to take oftentimes factors capital outlay, as it can be costly to do everything at once.
In those cases, a hospital may choose to budget for design and technology implementation in one fiscal year, and then budget for construction the following year to soften the blow.
Implementing multiple changes simultaneously could result in inefficiencies that come from learning a new software system amidst the inevitable disruption that comes with any construction process.
A clear, coherent and concise plan for rolling out multiple changes will help decision makers manage as smoothly, securely and cost effectively as possible.
Reconfiguration in action
New operational model emerges. An example project had a typical ED, which had become overcrowded. The team worked to find the most efficient way to care for and move patients through the ED. The initial solution was simply to add space they could grow into and renovate behind that, but the project grew into a completely new operational model for the ED, matching the level of care with patient need – and only directing those patients that need emergency services to areas where they can be appropriately served.
Analysis. An analysis of the initial proposal looked at the number of phases the project would require. While it might save some money, the proposed renovation would actually take longer than building an entirely new ED in front of the existing one.
To simplify the process and compress the schedule, the team is proposing a solution that completely replaces the ED and then backfills the space with other functions. This approach simplifies what would have been a multi-phase project and results in significantly less operational disruption.
The basic footprint of the ED does not substantially change but the cost savings are significant, and the new flow ensures that patients are treated fast, in the right environment, with fewer staff operating more efficiently.
New flow for high- and low-acuity patients
Revised entry sequence. While the project is ongoing, in the current floor plan design, the patient is dropped off under a canopy at the entrance and greeted by a registrar adjacent to a security checkpoint. Based on a few simple questions, a patient is either sent to a super-track area or registered for the standard ED. The layout moves patients smoothly from one step in the process to the next, keeping high- and low-acuity patients out of one another’s way.
“Super track” for lower acuity patients. These patients are directed to a separate “super-track” waiting room space within the ED where they can be treated quickly, bypassing the regular ED. Super track patients answer additional questions in an area that is configured similar to a series of intake rooms.
Patients enter these rooms through doors off the waiting room, while providers enter from the back side through a separate entrance. Here, the patients receive a consult and they may be treated and released, or sent to a lab or X-ray and onward to await test results and next steps.
The diagnostic equipment most often needed for ED patients—X-ray, CT and ultrasound—is located within the ED footprint, saving valuable time in transporting patients for testing. When the results come in, patients return to a consult room to receive instructions and then exit the hospital or move to an exam room for additional evaluation and treatment.
Separate corridor for high-acuity patients. Patients arriving by ambulance enter through a separate corridor to minimize disruption. The back corridor ties directly to the ambulance bay and patients are conveyed directly through the back corridor into trauma rooms, rather than passing through the main ED. Ambulance patients reach their destination with the utmost speed, and lower-acuity patients are spared the commotion and visual trauma of ambulance patients being rushed through the hallway.
Optimizing efficiency
The right treatment environment. The key to success in such projects involves analyzing the way the ED sees patients and finding ways to increase efficiency by treating the patient in the right environment as quickly as possible. This is just one example of how streamlining the flow of traffic increases efficient operations and makes better use of existing space.
It isn’t always necessary to expand the square footage when an optimized configuration enables more patients to be treated more quickly. Better flow means increased throughput, greater market viability and—the most important metric of all—higher patient satisfaction.
Care planning that benefits everyone. The right treatment environment is about more than efficiency. It also reflects the spirit of the 1986 Emergency Medical Treatment and Labor Act, which requires ED patients to be screened and/or treated regardless of their insurance or ability to pay. Redesigning patient flow for high- and low-acuity patients allows them to be treated in the appropriate environment for their condition.
The super track option additionally allows ED admission staff to ask questions about a care plan that is appropriate and then direct patients to an area that matches their symptoms more cost effectively. The super track solution benefits the hospital, which receives the same ED reimbursement, rather than the lower urgent care rate.
Ultimately, a strong master plan carried out by design and construction offers a decisive strategy to advance your ED.
