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Healthcare Facilities

Evidence-Based Design Interventions: Emergency Departments
Thursday, July 23, 2009

Evidence-based design interventions for Emergency Departments revolve around understanding and balancing critical patient perceptions and physician needs as well as designing and managing an entire facility to better manage patient flow.

  • Balancing patient privacy and ED team's need to directly monitor and access a patient is imperative. Visual or auditory barriers might impede timely intervention by a physician, while lack of privacy might lead a patient to withhold private health information. 
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    • A study in a university medical center's ED found that time to initial physician assessment was higher for chest pain patients placed in rooms farther from the staff work area or placed in rooms with doors rather than curtains. 
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    • Another study discovered that five percent of patients examined in curtained spaces reported withholding portions of their private history and refused parts of their physical examination because of lack of privacy. 
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    • IHI recommends the best way to balance needs of patients, staff and HIPPA is to provide enclosed treatment rooms with decentralized nurse stations to maximize room visibility. 
  • Designing a more welcoming Emergency Department will increase the number of patients that wait out time to see a physician. Crowded, noisy emergency rooms convey the wrong message to patients already stressed. 
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    • A study conducted at New York City's Weill Cornell Medical College examined the relationships between attractiveness of the physical setting and actual and perceived waiting times, quality of care, anxiety and staff-patient interaction in seven specialty out-patient practices in Manhattan. Results showed that a more attractive environment resulted in a higher perceived quality of medical care, lower levels of anxiety, and more positive interactions with staff. The study also reported patients perceived shorter waiting times.
  • Implementing evidence-based design to an Emergency Department is only a small part in improving quality care through design. Studies show that understanding patient flow throughout an entire healthcare facility and knowing where bottlenecks, causing delay in care, reside is imperative to relieving pressure on Emergency Departments. 

Our final blog of the evidence-based design intervention series will focus on design specified to improve patient care and safety in Medical-Surgical Nursing Units, medical offices and Neonatal Intensive Care Units.

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