The emergency department (ED) is a healthcare system’s 24/7 front door. Over the last decade, ED visits are up 32%, but capacity is down 7%. Universal care coverage will likely increase demand because of the lack of primary care access.

Healthcare leaders need to focus on meeting the needs of physicians, staff, and patients, and creating EDs that are adaptable for the future.

The architecture must also provide sufficient flexibility to accommodate wide variances in patient flow and emerging technologies. Consider the following six key issues when designing your next ED. 

  1. Sitting down for care
    Eighty percent of patients can be treated in a seated position, because they are not critically ill. They are considered ambulatory patients. Instead of occupying valuable space in a hospital bed, consider treating patients who are seated. One potential solution: a chair-centric format that requires less space due to a vertical, versus horizontal, configuration.
  2. Scaling up and down
    EDs exceed capacity just 10 percent of the time. It’s crucial to design EDs that are scalable to flex with patient volume fluctuations. Examples: scale from a one- to a two-bedroom configuration to maximize treatment spaces. Accordingly, medical utility provisions also need to be right-sized.
  3. Keeping care safe
    More and more people are having difficulty receiving acute mental health intervention. In turn, they are relying on EDs for care. Any disruption could cause security issues for hospital staff. Planners must develop appropriate, secure, and safe space for acute mental healthcare.
  4. Technology on tilt
    Leverage technology on all counts. Design for today—but keep in mind emerging technologies such as self-decontaminating materials and touchless sensors. Advanced telecommunications devices allow staff to make triage decisions long before the patient arrives. Hand-held advanced imaging devices are allowing clinicians to bring technology directly into the room, versus designing the environment around the imaging equipment.
  5. Controlling contaminates
    Mechanical, electrical, and plumbing concerns are paramount to planners when designing EDs. An integrated team approach allows technical professionals and planners to investigate space, barriers, and opportunities to mitigate infection and other airborne contaminates.
  6. Securing spaces
    It is important to perform a threat assessment before, not after, the ED is designed to review natural, industrial, and deliberate threats. Securing a portal entry, installing various scanning technologies, and developing a lock-down plan are critical planning and design aspects.

David Vincent, AIA, ACHA, LEED AP, is designer and director of HKS Team ED at HKS Inc.