Rethinking The ED To Accommodate High-Risk Infectious Patients
Emergency departments (ED) in the United States are experiencing high patient volumes, particularly with winter seasonal peaks. In addition to the resulting limited capacity to accommodate surges in demand, most EDs are poorly designed to protect staff, other patients, and visitors from highly contagious airborne transmission of an epidemic disease, such as the current COVID-19 pandemic.
Despite serious research, such as the ER One study and “Integrating Disaster Preparedness and Surge Capacity In Emergency Facility Planning,” by authors Frank Zilm, Robert Berry, Michael Pietrzak, and Amy Paratore, few institutions have incorporated new designs concepts that could respond to the volume and special needs at times like now.
As part of the 2018 Healthcare Design Breaking Through conceptual design competition, a team from the University of Kansas Institute for Health and Wellness Design, including myself and master’s students Zach Overschmidt and Bhaswati Mukherjee, explored “out of the box” thinking regarding ED design, including the specific focus on how to accommodate a surge in high-risk infectious patients. The challenge we set for our entry included how to look at the full range of the emergency care experience and how to cost-effectively design the ability to respond to infrequent but major disaster events.
Our first concept was to redesign patient arrivals by reconfiguring the traditional ambulance. The solution involved two components: a chasse (called an Ubulance) and interchangeable containers, which would be attached to the chasse based on the anticipated needs of an individual “run.”
One container component would be designed for low-acuity patient transport and for off-site treatments. The second module would be a traditional ambulance configuration, while the third module is designed to respond to major disaster events and for high-risk infectious patients.
Upon arrival to the ED, the container would be detached from the chasse and expand to function as a standard emergency care space, providing care in a protected environment until the patient is safe to move. When not in use, these containers could be warehoused at an individual emergency department or as part of a regional care system.
Our second concept was to design an ED for the modules, using a series of docking stations, some of which would be used on a regular basis and some held in reserve for a surge event. Conceptually, these stations would be similar to an airport gate, enhanced with an entry alcove that includes sinks, a decontamination shower, and storage of personal protective gear. The surge docking portal could be located in an area that would be converted from its typical use to the event scenario needs.
With this design, the surge capacity is located along the exterior wall of the results waiting area in the conceptual ED design, removing possible infectious patients from the waiting area while creating a separate quarantine zone. Patients would never enter the core ED unit they were safe for transport.
It’s reasonable to assume that the current pandemic will not be an isolated event—a reality that heightens the demand more out of the box thinking now and in the future. Our healthcare systems need to think through a comprehensive, cost-effective design that assures safe care. Tents in parking lots are a questionable approach. We can do better.
Frank Zilm, DArch, FAIA, FACHA (retired), is the Chester Dean Director of the Institute for Health and Wellness Design at the University of Kansas School of Architecture and Design (Lawrence, Kan.). He can be reached at [email protected].