In 2019, architecture and design firm HKS (Chicago) completed a redesign of the emergency department (ED) at Northwestern Memorial Hospital (NMH; Chicago) that included 16 vertical-chair pods taking up the same square footage of four traditional exam rooms.
Designed for low-acuity, fast-track treatment in the ED, the exam pods were a key component of a project to address a pressing problem, not just for NMH but every health system: How to treat more patients in the same or less space.
“Roughly 50 percent of patients who present to the ED don’t need a bed; they can be treated vertically (or seated),” said Dr. Deborah Wingler, global practice director, applied research, and partner at HKS. The pod design “could double the number of patients that clinicians can treat in the same space at the same time,” she added.
HKS, which had been working on the idea of low-acuity treatment stations for some time, decided to redouble those efforts by improving on the vertical exam room model implemented at NMH. The project team included Wingler and Colby Dearman, principal, architect, senior medical planner, and regional practice director for health based in HKS’s Atlanta office. Through a request for proposal process, HKS selected DIRTT (Dallas) as its manufacturing partner.
Working on multiple parallel paths, the team developed the concept for COVE (Clinical Observation Vertical Exam), a 57-square-foot modular exam room which won Best of Competition in the 2025 Nightingale Awards. In addition to the smaller footprint, the module could be dropped into any existing ED with a significantly faster speed to market.
“The greatest revenue lost is when a hospital has a space that can’t be used,” Wingler said. “With drywall, or what we call ‘bricks and sticks,’ a department could be down for three weeks. That’s patients not being seen. So the idea that you can come in and very effectively retrofit an entire space in way less time than you could by traditional methods just made a lot of sense.”
Following the presentation of the awards at the 2025 Healthcare Design Conference + Expo in Kansas City, Mo., Healthcare Design spoke with Michael Mullen, vice president, product development and strategy; and Benjamin Urban, CEO of DIRTT, who shared insights into the product’s design strategy as well as potential use cases.
Healthcare Design: What needs were you looking to address with COVE, and why?
Benjamin Urban (Courtesy of DIRTT)
Benjamin Urban: Emergency departments continue to face overcrowding, long wait times, and limited space for low-acuity patients. Many of these patients do not require admission but still occupy traditional exam rooms designed for higher-acuity care. COVE was developed to help emergency departments do more with less: optimizing square footage, improving patient throughput, and enhancing care delivery without compromising the patient, family, or staff experience.
Michael Mullen: From a product and design standpoint, one of the biggest challenges in emergency care is how difficult it is to update or expand clinical space without disrupting operations. Traditional construction makes even simple changes, like adding data, power, or medical equipment, time-consuming and messy. With COVE, we set out to create a modular platform that installs quickly, adapts easily, and makes future updates far simpler.
HCD: How did you approach the design process and what did you learn?
Michael Mullen (Courtesy of DIRTT)
Urban: Through an evidence-based design process, the team learned that COVE’s smaller footprint would be successful only if it preserved patient comfort, privacy, and clinical functionality. Feedback from clinicians emphasized the need for clear sightlines, acoustic separation, and adaptable lighting within the compact footprint. In response, the design was refined with an angled rear wall for sound control, integrated storage to reduce clutter, and adjustable lighting to support both patient comfort and clinical tasks.
Mullen: Over the course of development, we went through more than 20 design iterations to understand how patients, clinicians, and equipment would move within such a compact footprint. We used behavioral testing, foam-core mockups, and full-scale simulations to refine every placement, such as where a care partner might set a coffee to how a clinician reaches for supplies. Seeing teams interact with the space in real time helped us adjust the geometry, casework, and flow so the final product feels natural to use and aligns with real-world clinical practice.
HCD: What are some features of COVE’s prefabricated design?
Mullen: Every element is designed to be manufactured in a controlled factory environment using CNC programming and repeatable processes to ensure precision and consistency across each component. COVE’s modular assemblies are built so that nearly everything is completed before the product reaches the job site.
The casework arrives as a finished unit, and wall sections include pre-installed medical gases and utilities, ready to stand and connect in sequence. This level of prefabrication minimizes on-site work and makes installation almost turnkey, whether it’s being added to an existing ED footprint or incorporated into a new construction project.
The consistency built into off-site fabrication also means that if a hospital wants to add more COVE units years later, they can be manufactured and installed using the same specifications, with no surprises in fit or finish.
HCD: How did you design the product to meet the needs for low-acuity ED treatments?
Mullen: For low-acuity care, versatility is essential. We designed COVE for the clinical chair to support upright vertical care but also have the ability to recline and work with the adjacent bench if a patient’s condition changes. Integrated medical gases and monitoring ports are built into the DIRTT walls and accessible through openings in the casework, readily accessible to clinicians but designed to be concealed enough to maintain a calm environment. This combination of flexibility and readiness is essential in low-acuity environments where patient needs can shift unexpectedly.
HCD: How does COVE address patient flow and experience?
Mullen: COVE improves patient flow by giving emergency departments the ability to significantly expand their low-acuity capacity within the same footprint, because the module is designed to be a fraction of the size of a traditional exam room. By introducing more treatment stations in less space, teams can move patients through triage and assessment faster, reduce hallway care, and decrease the bottlenecks that often slow down the front end of the ED. The layout is intentionally organized so clinicians can complete most tasks within one zone, minimizing back-and-forth movement and speeding up treatment cycles.
From an experience standpoint, we focused on creating an environment that feels calmer and more intuitive than a traditional emergency department room. COVE’s design and color palette are informed by taking inspiration from patterns found in nature and the elevated experience of first-class travel. The actual design is based on the aesthetics associated with a high-end travel experience, such as a luxury jet, with patient controls to adjust lighting and charge mobile devices within close reach.
Softened geometry, cleanable wood-tone finishes, and a warm off-white palette help shift the space away from the starkness patients often associate with emergency care. The care-partner bench offers a defined, comfortable place for families to stay involved, compared to the standing room or hard folding chairs found in hallway triage.
HCD: How did you address cleanability, durability, and resilience in the product’s design?
Urban: All finishes and materials are selected for high cleanability and resistance to wear. Surfaces are designed to be installed modularly and demountable, which means if one panel needs replacing, it can be easily swapped out without impacting any other elements of the COVE module. Manufacturing quality is verified through cycle validation, sampling inspections, and powder-coat testing to ensure long-term performance. The system is built for longevity, supported by a 10-year warranty.
Mullen: COVE’s material strategy also reduces environmental impact, with components made from nearly 70 percent post-consumer recycled materials and selected to minimize harmful chemicals in the care environment. Enabling reconfiguration instead of replacement of parts, the system helps keep waste out of landfills and supports more sustainable long-term facility operations. As each piece fits together in assembly built with Design for Disassembly (DfMA) principles in mind, reconfiguration can be done without destroying parts.
HCD: How does COVE help to address concerns with cost of construction?
Urban: COVE delivers measurable savings through prefabrication and efficient installation. Estimates calculated by the project team using industry benchmarks and standards show up to a 6 percent reduction in first costs, 60 percent shorter construction timelines, and a 25 percent increase in patient throughput during construction compared to conventional methods. Its durable, modular design also reduces maintenance needs and extends product life.
Mullen: We give health systems flexibility to tailor COVE to their operational and financial needs without compromising the character of the product. Certain features are selectable based on preference. For example, two large back-painted, edge-lit glass tiles on each side of the module can be replaced with solid, non-lit thermofoil tiles, the TV can be omitted, or the integrated exam lighting, optionally mounted in the ceiling, can be removed if a system relies on mobile lighting carts. These options allow elements COVE to be value engineered to fit the priorities of each organization while maintaining the overall design intent.
Because modules are built off-site with standardized components, costs remain predictable and less vulnerable to on-site labor variability. And since the system is designed for easy updates, hospitals avoid the long-term costs of major renovations down the road.
Robert McCune is senior editor of Healthcare Design and can be reached at [email protected].
