When Wellstar Kennestone Hospital’s emergency department (ED), in Marietta, Ga., was built in the 1970s, it was predicted that the quaternary care center would serve about 60,000 visits annually. “Over time, of course, that number has continued to increase to the point that we’ve seen 140,000 visits per year,” says Mary Chatman, executive vice president, Wellstar Health System, and president of Wellstar Kennestone and Wellstar Windy Hill hospitals (Marietta).

In response, 84-bed ED was forced to get creative to address rising demand, Chatman says, for example, adding hallway beds to increase capacity and bringing in a modular treatment unit for temporary use during a past flu season, which then became a long-term care space. In spite of these challenges, the ED, which serves as a Level 2 trauma center as well as a comprehensive stroke and cardiac facility, had high patient satisfaction scores, Chapman says. “It was a true testament and demonstration of how you could take what you have and work with it.”

Still, 10 years ago, hospital leaders began seeking a better solution, planning a new ED with 166 beds (133 universal beds and 36 transitional beds) designed to support up to 200,000 visits per year (with space for 36 additional beds for future growth)—making it one of the busiest EDs in the state of Georgia and second largest in the country when it opened in July 2020.

Mapping out goals and solutions

Located in a residential community, initial plans sought to locate the new ED on the existing hospital campus, but the idea got pushback from neighbors because of the proximity of the replacement ED to nearby houses. So the hospital purchased a triangle-shaped parcel of land across the street to house a new, two-story ED. This solution provided space for improving efficiency and care services through a modern ED, but presented another challenge: connecting the new ED to the main hospital.

The solution was a two-story connector built across the two-way road that separates the two facilities, with one level designated for transporting patients who are being admitted to the hospital and the second for visitors and family members to move between the two spaces without having to go outside. “We wanted to make sure that access was fairly direct for a patient coming from the emergency room to surgery and the CATH labs and other interventional spaces,” says Matthew Manning, principal at ESa who served as design manager on the project, with ESa (Nashville, Tenn.) and Huddy HealthCare Solutions (Fort Mill, S.C.) collaborating on the project. “A lot of the planning was based strictly on where those existing services were in the existing hospital where we can make a connection.”

Another project goal was locating ancillary services within the new ED space to improve care as well as support operations. “We really wanted to make the emergency department to be almost a hospital within itself,” Chatman says. For example, an imaging suite with CTs, MRI, ultrasound, and X-ray services provides access to diagnostic services without needing to transport patients to the main hospital. “The more we can actually make it a resource-heavy diagnostic center, the easier it is to make decisions about what the next step is for patients,” says Dr. Vik Reddy, chief medical officer at Wellstar Kennestone and Wellstar Windy Hill Hospitals.

To accommodate the site’s natural slope, the project team structured the two-story ED atop a 75,203-square-foot parking garage. The first floor of the 263,000-square-foot building houses a 12-bed trauma pod and a separate 16-bed pediatric ED. Each of the trauma rooms is planned to accommodate in-room imaging while three have direct connection to a CT for immediate access. An isolation room located between two adult and pediatric triage areas on the first floor is used to quickly relocate someone who poses an infection risk. To maximize flexibility, the room utilizes airborne isolation technology and ligature-resistant features so it can also function as a de-escalation room for behavioral health patients, when needed.

The second floor features a 12-bed behavioral health unit with separate pods of eight adult and four pediatric rooms. The units include private patient rooms with ligature-resistant features such as safety hardware and accessories, a day room, shower facilities, and a secure intake area to allow patients in an agitated state to de-escalate before entering the unit. An adjacent six-bed ED pod on the second floor is also designed similar to the behavioral health rooms to allow future flexibility. “We ultimately decided that for the number of visits that that they were anticipating seeing that it would be better for the behavioral health unit to be located on the second floor,” Manning says. “It’s more isolated, so it would be more difficult for patients to elope, and we could give them some daylight access and other features that you might not be able to do if it was on the main floor of the ED.”

Community connections

To help streamline traffic, the hospital includes three entrances, including separate entrances for adult and pediatric patients and a dedicated space for trauma and ambulances, with three ambulance bays for different levels of acuity as well as parking for up to 17 ambulances. “It’s close to our high-acuity area so those patients can get right to that zone from the emergency medical services drop off,” says Marianne Hatfield, vice president and chief nursing officer of patient care services at Wellstar Kennestone Hospital. “That wasn’t easy to do with a single entry in the past.” There’s also direct access to the trauma care area from the rooftop helipad via an elevator.

For the interiors, Chatman says the project team tried to tie in with the aesthetics of the main hospital, but in an approach that was appropriate for the different patient populations the ED serves. For example, patient pods in the adult ED have a tree theme, with corresponding colors and graphics for each, while the pediatric ED has a water/bubble theme. “All of the signage plays off of that theme and the colors are a little bit brighter in the pediatric pod,” Manning says.

Furthermore, the project team worked with the local government officials and the county to make sure the architecture tied in with the community. For example, sidewalks were located around the new ED to provide access to green space on campus. The project team also tried to minimize how many trees were cut down during construction to keep the site as lush as possible. Finally, the connector bridge was outfitted with the city’s “M” logo. “We see it as a bridge to the Marietta community, and as a bridge to connecting our services,” Chatman says. “It stands out in the community.”

Anne DiNardo is executive editor of Healthcare Design. She can be reached at anne.dinardo@emerald.com.

For more on design trends in emergency departments, check out the article, “Crucial Balance,” in Healthcare Design’s March issue.


Project Details:

Project name: Wellstar Kennestone Hospital Emergency Department

Project completion date: July 2020

Owner: Wellstar Health System

Total building area: 184,093 sq. ft. new construction; 597 sq. ft. renovation; 75,203 sq. ft. parking garage

Total construction cost: N/A

Cost/sq. ft.:  N/A

Architecture: ESa (Earl Swensson Associates)

Interior design: ESa (Earl Swensson Associates)

General contractor: Brasfield & Gorrie

Engineering: Kimley-Horn (civil); KSi (structural); SSR (MEP)

Builder: Brasfield & Gorrie

AV equipment/electronics/software: Mazzetti + GBA (consultant)

Carpet/flooring: Shaw Contract, Res-Tek, Johnsonite, Altro, Mannington, Shaw, Stonepeak, Sherwin Williams

Ceiling/wall systems: Armstrong, National Gypsum

Doors/locks/hardware: Best, Pemko, McKinney, LCN, Von Duprin, Ives, Stanley, Marshfield, Mesker

Fabric/textiles: TJNG Partners Specified (consultant)

Furniture—seating/casegoods:  TJNG Partners Specified (consultant)

Handrails/wall guards: Inpro, Nudo Trim

Headwalls/booms: Stryker

Lighting: Cooper Lighting, Hubble Lighting, Lutron Lighting

Surfaces—solid/other: Corian, Wilsonart, Zodiaq, Hanstone

Wallcoverings: National Wallcovering, Wolf Gordon, Altro, Sherwin Williams