Emergency departments continue to struggle with increasing demand, admissions increased by 22% between 2008 and 2016 and continue to rise.
This increase is a symptom of wider challenges throughout the health and social care system and only major changes in our healthcare system can address this demand.
As part of a more integrated approach to healthcare delivery, alternatives to the emergency department such as Urgent Treatment Centres are being developed. Together with improvements in primary care access and out of hours GP services, emergency departments can focus on genuine emergencies.
These changes, however, will take time to realise and in the short term demand is predicted to continue rising.
Faced with these challenges, how does the design of a new emergency department respond to the current capacity demands, whilst providing an environment that is able to respond to future needs?
We view emergency departments (EDs) a bit like high performance engines. Physical and less-tangible, human-controlled components working within an environment that runs efficiently whether cruising or maxed out.
We don’t just design the physical. Working with clinical teams, we shape the flow of movement.
Managing flow through the emergency department decreases congestion, providing a better experience for patients and staff. The layout should enable the efficient flow of patients through the department ensuring that people are seen by the right clinician, in the right setting, at the right time.
The consideration of flow extends beyond the immediate emergency department. The Same Day Emergency Care (SDEC) initiative seeks to ensure that wherever possible patients can be assessed, treated and sent home in the same day avoiding unnecessary admissions. Just like an engine, flow out is just as important as flow in.
Flexibility is key. The layout should support efficient staffing during periods of high and low activity. Complex projects such as emergency departments take many years to commission and build whereas emergency medicine practice changes rapidly.
The path to efficiency requires a hybrid methodology. Both in design and delivery.
The design of acuity adaptable treatment and assessment spaces provides flexibility in use, whilst minimising the risk of errors by using consistent configuration. These spaces can cater for a complete patient journey – from diagnosis to treatment and discharge. They also anticipate future scenarios with increasing numbers of patients with more serious conditions. This is a true hybrid space, and needs to be designed as such.
Highly responsive environments.
A good engine is often labelled highly responsive to human intention and interaction. The same is true for EDs. Layout, flow and environmental qualities should support staff in the delivery of care.
Listening to staff, we know that effective communication is a requirement in every scenario. In the frenetic environment of an emergency department, visual connection is critical. Sight lines, day lighting and open space help facilitate. Equally, connected private spaces are necessary for confidential discussions.
Much like engines are changing beyond recognition, 11 with the ability to achieve more with less.
We are addressing these key issues on a daily basis – currently working on the improvement of four emergency departments including a major project working closely with senior clinicians at Derriford Hospital, Plymouth. Together, we are shaping their emergency departments to be fit for the road ahead.