Designing an accident and emergency department is a challenging task given the complex demands and relationship with other departments within the hospital and outside world. A good design must address the shot-comings experienced by many accident and emergency departments that are in use today. Some of the key challenges that need addressed are waiting time for patients, access to the facility, violence towards and damage to property, way finding to and within the department.
A well designed facility not only supports but enhances patient care and results in operational efficiencies. Design features that must be considered are usage levels for mean, peak and lean periods; organizing assessment, diagnostic and treatment areas, segregation of urgent care; out-of-hours consultations; unscheduled work and major assessment and trauma areas.
Even though medical emergencies constitute more life threatening situations than surgical emergencies, most departments are better geared to cater to the latter. Designs that cater to the “see and treat” clinical approach perform better in reducing waiting times and improving patient experience. Staff must be able to survey the treatment, assessment and waiting areas from a single location.
The waiting area must be in directly line of sight from the reception and security stations, to ensure that if a patient becomes sicker they will be noticed. Moreover it will be better able to control crime and incidents be more speedily addressed.
Reserve capacity must be provided to cater to unforeseen epidemics and disaster situation with full back integrations between first responders, ambulance deployment, and support services and accident and emergency departments. Provision must be made in the design to have flexibility between assessment and treatment rooms to change depending on demand.
It is imperative that the design render natural way finding of the patients and visitor to ensure that visitors can easily find their way to locations like reception and waiting areas. It is also important that they must not unintentionally access sensitive areas like treatment rooms, resuscitation area etc. Natural way finding compliment access schemes between departments, within the department and the main hospital. Design must essentially cater for the swift transfer of patients through the entrance and provide alternate routes.
Externally the department must be accessible and routed out the general flow of traffic. Alternative routes other than the ambulance and main entrance must be provided for contingency situations
The author is managing director of Cedara Healthcare, a Hyderabad based hospital consultants providing specialized consultancy services like hospital design services, healthcare design services, clinical design services etc.
