Ideal ED structure and design

FunctionEnvironment safety- patient/staff Space- system Expedite assessment, care, TX and disposition Cater unique patient population Maximize human resources

Emergency Department
ED Overview Fundamentals Approach to ED Design Baseline Programming Metrics The Department The Patient Room! Typology of the Efficiency Based Planning Opportunities to Increase Efficiency Efficacy of the Design

Dynamics of Emergency
Front door to the hospital Speed = Patient Satisfaction High intensity, high stress, for all participants Inefficiency occurs during moderate volumes

Emergency Department Triage System

Function of triage
Identify life-threatening conditions and determine acuity level of each patient

ES I
M E R G E N C Y EN VD EE RX I T Y

Is patient dying ?

Yes Level I

No Level II, III, IV, V

Can patient wait ?

Yes Level III, IV, V No Level II

How many resources ?

TWO Level III ONE Level IV

NON Level V

What are resources Labs ECG-X-rays C-T MRI IV Fluids /hydration IV /IM Medication Specialty consult Simple procedure Complex procedure

Reassessment in triage
Level 1 =Continuous Level 2 = every 15 min Level 3 = every 60 min Level 4 = every 60 to 90 min Level 5 = every 2 hours

Key concepts

Acuity level change Choose higher acuity when in doubt

Key concept
Discontinue assessment and transport the patient immediately to the treatment area if immediate care is needed. Do not delay treatment to finish the assessment

Key Concept
Never assume the accident caused the presenting condition. The presenting condition may have caused the accident.

Triage process
Establish priorities Scientific method Importance of time

Triage decision
Step1- visual Step 2- chief complaints Step 3- focused assessment Step 4- pose hypothesis Step 5- determine acuity Step 6- reassess the acuity

Remember That:
Effective triage gets the patient To the right place. At the right time. With the right care provider.

Staff in the Emergency Department

Nurses Techs Radiology Lab / Phlebotomy Housekeeping Security Administration Registration Social Services Dietary Respiratory Bed Placement

Trauma Level
Level I: Offers comprehensive emergency care 24/7, with at least one physician on duty who is experienced in emergency care. There is in-hospital coverage by members of the medical staff or by senior level residents for medical, surgical, orthopedic, obstetric/ gynecological, pediatric and anesthesia services. Other specialty consultation is available within approximately 30 minutes. Hospitals offering these services are often referred to as regional trauma centers.

Trauma Level
Level II: Offers emergency care 24/7 hours a day, with at least one physician experienced in emergency care on duty in the emergency care area and specialty consultation available within approximately thirty minutes.

Trauma Level
Level III: Offers emergency care 24/7 with at least one physician available to the emergency care within approximately 30 minutes through a medical staff call roster. Initial consultation over the phone with a physician is acceptable.

Trauma Level
Level IV: Offers reasonable care in determining whether an emergency exists, renders lifesaving first aid, and makes appropriate referrals to the nearest organizations capable of providing needed services.

The Department
Size Sub-Departments Type Needs Based Configuration Adjacencies

AMBULANCE PARKING SURGERY

PUBLIC PARKING

EMERGENCY DEPARTMENT

RADIOLOGY LAB

PHARMACY

IN PATIENT HOSPITAL

OUTPATIENT CLINICS

External Adjacencies

FOOD SERVICE

FAST TRACK M

WAITING R PUBLIC ENTRANCE GREETER REGISTRAR

SECURITY TRIAGE PATIENT EXAM MS R

X-RAY

AMBULANCE ENTRANCE

Internal Adjacencies

IMAGING CT/MRI

TRAUMA

CHEST PAIN / BSERVATI N

EMS SUPP RT

DEC N HAZ/MAT

NURSING AND SUPP RT

PSYCH MS R

PATIENT EXAM R MS

The Room
Size Type Configuration Adjacencies

The Patient Room Universal Design Adequate Circulation Patient Zone Family Zone Care Giver Zone 120 s.f. min per Guidelines

Minimum Recommended Size

Must Support Clinical Care Staffing Families Healing

Fast Track

Open Bay 80 s.f. min Exam Room 120 s.f. min Universal Design 130 s.f.

Trauma Patient Room

Mini Operating Room Open and Flexible Cleanable Visibility / Access

Psych Patient Room 175 s.f.

Seclusion Security Sound Control Concealed Services Tamper-Proof Durable Finishes Visibility Lockable Toilet Room Removable Furniture

Amenities for the Patient Room

Natural Light Dimmable Light Fixtures Sound Control Access to Technology Television with Internet Access Communication with RN Adequate Family Space Sustainable Design

Configurations
Race Track Pods Interlocking Linear Model Circular Pods, Linear/Interlocking