When Wellstar Kennestone Health Center in Marietta, Ga., started preparing a replacement for its outdated and small 1970s-era emergency department (ED), the Ebola epidemic was still top of mind. It was 2016, and issues like how to evaluate possibly infectious patients before getting in a facility and the requirement for isolation rooms was necessary subjects in conversations about health care design. That truth affected the 263,000-square-foot, 166-bed replacement ED, which opened in July 2020 and consists of an outside decontamination location, 14 unfavorable pressure spaces, and areas to act as de-escalation/isolation/decontamination for clients presenting with infectious illness, behavioral health, or chemical contamination problems. “I give [Wellstar] credit for thinking ahead,” states Matthew Manning, principal at ESa who acted as design supervisor on the job, a cooperation in between ESa (Nashville, Tenn.) and Huddy HealthCare Solutions (Fort Mill, S.C.).
Those techniques have now served the ED during the existing COVID-19 pandemic. “We’ve actually managed rather well with the 14 unfavorable pressure spaces that were designed for the brand-new space, because we can put our highest-acuity favorable clients who require to go through aerosolized treatment interventions in them,” states Mary Chatman, executive vice president at Wellstar Health System and president of Wellstar Kennestone and Wellstar Windy Hill (Marietta) healthcare facilities. In addition, when Georgia’s state government was looking for treatment areas to address prospective COVID-19 client surge, the 166-bed Wellstar Kennestone ED was identified as one of the few hospitals with brand-new readily available beds (it hasn’t been required in this capacity, to date).
Facilities that didn’t have pandemic-ready ED spaces have actually also spent the in 2015 seeking options to control the air-borne transmission of COVID-19 and heightened infection control practices. Methods have varied from transforming outside areas to alternate care sites for low-acuity patients, adding clear plastic barriers in between waiting space seating to support social distancing, and installing window fans in existing patient rooms to exhaust air and develop negative pressure spaces.
Moving forward, market leaders state it is essential to stabilize long-term methods that address crisis care with the daily difficulties EDs deal with, such as the rise of behavioral health or pediatric clients providing at their door along with supporting team member and their wellness. “We’re beginning to discuss what being genuinely resilient ways,” states Deborah Wingler, health research lead at HKS (Dallas), “and after that realizing that our ED environments need to be more active and able to respond to not just this pandemic however future things that we can’t even see today.”
Being (next) pandemic ready
Reviewing the past year, Marvina Williams, registered nurse and associate principal, health, at Perkins & Will (Atlanta), says one lesson that stands out to her is the need for “versatility and versatility.” “ED staffs all over the nation are needing to adapt their center spaces and workflows to fulfill the needs of patients, and a great deal of places are having a tough time due to the fact that they do not have that flexibility developed into their ED,” she says. Without existing air-borne seclusion rooms or exam rooms with independent ventilation systems, some facilities rushed to create short-term COVID-19 wings or retrofit existing areas. Moving forward, designers state more attention needs to be paid to creating EDs that can deal with a variety of situations– from mass contamination events to seasonal influenza spikes. “Versatility, versatility, and efficiency are things that you buy,” states Brian Sykes, health care practice leader at Perksin & Will (Washington, D.C.).
For example, an ED project for Orlando Regional Medical Center (Orlando, Fla.), designed by HKS, integrates a grouping of rooms that functions as an urgent care pod however can alter to pandemic mode at the flip of a switch to end up being negative pressure with 100 percent outside air. The system likewise has its own entry and waiting location to use during this mode, to offer physical separation from the remainder of the ED. “That’s the kind of resiliency we’re discussing,” states Jason Schroer, principal and director of health at HKS (Dallas).
Reconsidering how clients– many getting here with a variety of requirements and conditions– go into a facility is also essential. “What we’re finding out is that the ability to initially different individuals from the beginning is truly important,” Wingler says. Solutions for redesigning the threshold can range from including a vestibule where screening is done to making use of an outdoor triage area to having numerous entryways so that during a crisis, one could be identified for specific clients while the others continue to serve the general client population. “There are various permutations to do that, but at the end of the day, there requires to be thoughtful factor to consider provided to how you start to isolate, if required, and secure others,” she says.
At Wellstar Kennestone Healthcare facility’s brand-new ED, an isolation room located between two adult and pediatric triage locations on the very first floor is utilized to quickly transfer somebody who presents infection threat. To maximize versatility, the space uses airborne isolation technology and ligature-resistant functions so it can also work as a de-escalation room for behavioral health clients when required. “When you combine them and use the space in a versatile method, it makes it a lot simpler sell and it puts [healthcare facilities] in a far better position to take care of clients in today’s climate or the next circumstance,” Manning says.
Marianne Hatfield, vice president and chief nursing officer of client care services at Wellstar Kennestone Hospital, states although the system hasn’t gone back to pre-COVID-19 volumes yet, the brand-new ED has the flexibility and forward-thinking systems in place to support care groups as they adjust to changing requirements. “We desire our community to feel great that they must not postpone looking for care due to any fear about being exposed to contagious clients,” she says. “We in fact think the health center’s the most safe location to be. Our private rooms and several specialty care zones have actually been established for simply this factor.”
Specialized care needs
Beyond the next pandemic, disaster readiness is another subject being resolved in today’s EDs, particularly in ambulance bays where task groups are layering in several systems to make it possible for care delivery to support triage or decontamination in case of a mass casualty occasion. For instance, as part of the University of Virginia (UVA) University Medical facility expansion in Charlottesville, Va., which included a new ED, the ambulance deck canopy was equipped with drop-down showers and drapes so water can be brought in to decontaminate mass groupings immediately, while electrical connections were contributed to the column to support generators or other power needs. “You want to be able to deal with [patients] outside and not bring them into the center,” Sykes says. “Health centers are ending up being more sophisticated about this subject.”
Facilities likewise are addressing how to deal with specific patient populations coming to the ED for care, including behavioral health and pediatric patients– making specialized care spaces a must-have in the ED. Acknowledging growing need for pediatric services at Wellstar Kennestone Medical facility, the task team developed a 16-bed pediatric ED with a separate waiting location within the larger emergency care environment. “Kids aren’t little adults. Their requirements are distinct, and you’re usually treating a family, as well,” says Dr. Vik Reddy, chief medical officer of Wellstar Kennestone and Wellstar Windy Hill health centers. “It was really important to have a different pediatric emergency department, with pediatric materials and nurses with knowledge, and likewise an aesthetically and aesthetically pleasant place for children.”
UVA University Hospital took a comparable method with a module of spaces for pediatric clients, with a dedicated check-in and waiting area with kid-sized home furnishings and a big interactive wall that represents the topography of the Shenandoah Valley. “It’s a positive interruption aspect for them while they’re waiting to be seen within the ED,” Sykes states.
Sykes includes that there’s a growing acknowledgment that behavioral health requires to be a concern, too, with EDs becoming “among the cutting edge of treatment.” Manning agrees, saying the topic is turning up more frequently in discussions with clients.” [Behavioral health] is probably the other pandemic that emergency departments have actually been seeing for several years and will continue to see,” he states. “Nobody can adequately predict their behavioral health population, and whenever we ask, we always get a number that’s more than you think it will be.”
In response, more facilities are moving beyond a couple of spaces tucked into a corner of the ED to developing truly designated areas. At Wellstar, in addition to the de-escalation space on the first floor, the two-story ED homes a 12-bed behavioral health system on the 2nd flooring with 8 adult and 4 pediatric personal spaces that are arranged into different pods, as well as a day room and shower centers. An adjoining pod of general adult patient care rooms are created with ligature-
resistant functions to provide flex space for extra care. “We’re going to see a lot more clients who have behavioral problems, so up until they get boarded to a formalized inpatient facility, having a real superior protected behavioral system is crucial,” Reddy states.
Chatman includes that dealing with these patients in spaces developed particularly to their needs rather than in a conventional ED test space not just decreases threat for patients and personnel but likewise conserves time during room turnovers by removing the need for staff to get rid of equipment and supplies that pose a safety danger. Additionally, in addition to ligature-resistant features, job groups are incorporating overall best style practices, consisting of access to daylight and relaxing color schemes. For instance, at UVA University Health center, behavioral patient rooms consist of clerestory windows– an essential function considering that some clients can remain in spaces for 24 hr or more up until they can be transferred to an inpatient or specialized care center, Williams states.
Focusing on caregivers
Another one of the biggest takeaways coming out of the in 2015 has actually been the significance of taking care of frontline workers, a number of whom have been putting in grueling hours and sustaining extreme emotional and physical needs. Traditional solutions such as personnel break rooms in the ED, sees to nature, outside areas, and access to daylight remain essential. But design professionals say among the very best ways to support caretakers is through the total environment, consisting of versatile layouts, accessible group stations, and exam rooms where materials are stocked and quickly accessible. “A great deal of times when you enter an ED that’s kind of grown amorphously gradually, that things doesn’t get considered and it might just be a genuine bear to operate in it,” Manning states.
For the Wellstar Kennestone Health center, he notes that the 166-bed ED is segmented into 12-bed pods, each with its own devoted clean supply area, strong holding area, personnel toilet, nutrition, and other personnel areas to support effectiveness and keep strolling ranges workable.
“We understand that the ED environment is chaotic, at best,” Wingler adds. “So we require to make sure that the people who serve and supply care have the area they need to do that and do that well.” In early 2021, HKS revealed that it partnered with the Emergency situation Medicine Foundation (Irving, Texas), a not-for-profit company founded by the American College of Emergency Physicians (Irving), to award a research study grant to the Health Style Lab at Thomas Jefferson University (Philadelphia) to take a look at how ED style can impact staff stress and burnout. The Health Design Lab’s research study will concentrate on the several factors creating stress while likewise supplying tools and processes for revamping existing ED areas. “Doctor and resident burnout has actually been a big concern,” Wingler says. “This is taking the step to state, fundamentally, our company believe that the developed environment can make a difference.”
Sykes includes that he anticipates conversations with hospital management about delivering the right ED facilities for nurses and physicians to treat their clients will acquire more seriousness and factor to consider. “Yes, [preserving] patient care and fulfillment is job one, however possibly one of the most effective methods to get really fantastic fulfillment is to treat your personnel well by providing that infrastructure,” he says.
For a case study on the Wellstar Kennestone Medical facility emergency situation department and how the project group got rid of website obstacles to deliver a two-story center that broadened bed capacity and services, as well as extra images, go to HCDmagazine.com/ wellstar-kennestone-ed.
Anne DiNardo is managing editor of Healthcare Design. She can be reached at anne.dinardo@emeraldX.com.