Whether going to the emergency room (ER) for a broken bone or a suspected heart attack, those who come through the doors expect and deserve timely treatment. An emergency room’s construction design and layout can play a big role in streamlining and improving the experience for both patients and caregivers.
Key emergency room construction design objectives include reducing patient waiting times, maximizing capacity, ensuring security, and improving productivity and patient outcomes. To achieve these goals, architects, construction managers and project owners need to take a holistic approach that considers each area’s impact on the whole.
Emergency Department Exterior and Placement
When thinking about emergency department design and construction, it can be helpful to approach it from the perspective of a patient. Even before they walk in the door, they will need to find their way there. Proper placement of an ER is critical as you don’t want those in distress confused over which hospital entrance or road to take. Most modern emergency departments look like independent buildings even when attached to a hospital. This difference in design and architecture can help the ER stand out. Clear wayfinding signage, both inside and out, helps promote easy access.
Design of Ambulance Bays
Architects, construction managers, and many healthcare project owners know ambulance bays must allow for quick, direct access and avoid potential delays from traffic in parking lots or busy streets as much as possible. In Wisconsin and Iowa, at least two ambulance bays are required. These bays should be “drive-through,” meaning an ambulance can pass through without having to back out. Independent entrances for ambulances also need to have wash stations to address potential exposure to drugs or chemicals.
A major part of building new ambulance bays is having the construction manager communicate the transition and new route to surrounding emergency departments, first responders, and fire departments. They will need to know when and where to stage and whether a temporary ambulance entrance needs to be used.
Accessible Reception Desk and Waiting Room
A reception desk and check-in area should be in clear sight upon entering the ER’s double doors to assist and direct patients where to go. Within close proximity, architectural designers often include an administrative workspace in the plans where insurance information and other details can be collected. Quickly assessing a patient’s needs upon arrival helps get them the treatment they need.
In the event low acuity patients need to wait in the waiting room, providing comfortable seating can help ease discomfort. If higher acuity patients take precedence, comfortable seating can reduce anxieties associated with longer wait times among those with lower acuity. It’s important to have the waiting room also serve as an observation area where staff can easily see whether someone’s condition worsens and immediate medical attention becomes necessary.
A simple yet sometimes forgotten element is to incorporate easy-access restrooms in waiting areas so patients and loved ones don’t have to wander throughout the hospital to find one. Also consider creating some privacy for guests who are experiencing distress, worry, and fear after having brought a loved one to the ER.
Efficient Treatment Bays and Nurses Stations
Nurses and physicians prefer to have a 360° view of patient rooms at all times, which can lend itself to a podular ER design. ER pods branch off a central nurses station and allow an entire team to work together to address the needs of patients. It also allows straight-line views into treatment rooms.
The Facility Guidelines Institute (FGI) 2022 edition of Guidelines for Design and Construction includes provisions for a flexible secure treatment room in the ER. This room needs to be able to serve as either a secure holding room or a single-patient treatment room. Modular components and partitions offer adaptability so that staff can adjust the space to patients’ direct medical needs. Glass doors instead of curtains are increasingly being used to once again maintain a clear line of sight.
Triage areas allow nurses to sort patients into various treatment bays based on the level of urgency, such as resuscitation zones or rescue rooms. Triage bays often feature foldable walls so that they can be converted into walk-in rooms.
Your architect and construction manager can share examples of what these environments look like.
Infection Control Measures
Emergency room construction and design teams must mitigate the risk of airborne or waterborne pathogens and particulates and conduct an infection control risk assessment (ICRA). Some infection control measures include dust suppression, proper material routing, and no-contact door handles and faucets. All surfaces — from healthcare flooring and countertops to fixtures — should be antimicrobial and easy to clean.
Negative pressure rooms help to isolate airborne pathogens and prevent them from circulating through HVAC systems. An ER department’s healthcare HVAC system is a specialized area that requires in-depth knowledge of proper air changeover rates, filtration, and placement. Proper cooling and humidity controls also contribute to patient health and staff productivity.
Security is being enhanced across entire hospital facilities, such as video surveillance at all public entrances, duress alarms, and key badge readers for access to secure areas. Bullet proof glass partitions may even be installed at reception desks.
ER departments require additional measures and should be capable of being locked down in the event of an emergency. ERs in high risk areas, such as those near jail facilities or in high crime areas, may need special detention rooms that limit a patient’s access to medical devices or escape routes. These rooms might feature secure rolling barricades that lower to cover medical devices and supplies, hard lid ceilings (drywall) instead of ceiling tiles, and customized doors that can’t be blocked or barricaded from the inside. When not in use by inmates or crime suspects, these fully functional rooms can still be used for general patients seeking care.
Construction Phasing and Mechanicals
Many hospital administrators expect emergency department construction or renovations to happen in phases, but it is sometimes spread out over a longer period of time than expected. Because it’s such an active and critical area of the facility, smaller portions of an ER project typically need to happen at a time to minimize disruption.
Additionally, it’s not unusual for an ER construction project to necessitate work in other parts of a healthcare facility. For example, existing mechanical and electrical systems are often routed through other areas of a hospital. When working on the ER department, the construction team will need to isolate those systems and branch out into those areas to ensure proper power and operation.
Another example is medical gas lines that need to tie into an existing system. It’s not uncommon for temporary portable units to be brought in while the main system is shut down. Backup systems need to be implemented to ensure operations remain up and running 24/7. When it comes to hooking up systems, an exhaustive transition plan helps to ensure seamless switchovers. Communication between the construction team, physicians, and facility managers is critical.
There is much more to consider when planning a healthcare construction project. Download our helpful Healthcare Construction Planning Guide below to learn more about these and other considerations.