Colorado-Real-Estate-Journal_414129

August 7-20, 2024 - Page 21 www.crej.com Health Care Design E mergency departments are the frontline of medi- cal care, handling everything from minor injuries to severe trauma cases. In the United States, emer- gency rooms operate under the Emergency Medical Treatment and Labor Act, which mandates that anyone seeking care at an emergency room must receive it, regardless of ability to pay or con- dition. This federal law ensures that no individual is denied emer- gency services, but it also means EDs must be prepared to handle a high and often unpredictable volume of patients. Recent reports indicate that there are approxi- mately 139.8 million patient ED visits annually, accounting for nearly half of all medical care pro- vided in the country. Overcrowding in EDs is as pressing an issue here in the West- ern U.S. as across the country, exacerbated by the increasing fre- quency and severity of mass casu- alty incidents. These include natu- ral disasters, mass violence, l a r g e - s c a l e accidents, or p a n d e m i c s and create a sudden influx of patients with vary- ing degrees of trauma and medical needs, overwhelming local emergen- cy medical ser- vices and hospitals. This surge can lead to overcrowding, prolonged wait times, and increased pres- sure on health care staff. Effective management of these situations requires robust surge capacity planning and a built environment that supports these protocols and practices. The rise of mass casualty inci- dents combined with an increasing demand for emergency services and a shrinking number of active e m e r g e n c y rooms, poses s i g n i f i c a n t challenges for EDs nation- wide. Data shows that in just a decade, ED demand i n c r e a s e d by 59% and readmissions i n c r e a s e d by 36%. The burnout rate among emer- gency department staff is over 60%, the highest among all spe- cialties. In the context of ongoing dis- cussions about improving health care infrastructure and enhanc- ing community resiliency, health care architects and researchers at Page, in collaboration with our health care clients regionally and across the nation, have system- atically reviewed evidence, best practices and protocols. Together, we have developed a design and planning guideline for resilient EDs that focuses on spatial needs and care processes aimed at reduc- ing length of stay in emergency departments and enhancing the flow of patients, care teams and materials during surge events. It offers specific strategies across multiple scales of the environment to assist with managing surge events while ensuring the physi- cal and mental well-being of care staff. Through multiple ED projects we have completed in the state, many of these strategies have been successfully implemented in Colo- rado. While presenting the entire guideline is beyond the scope of this article, here are three specific spatial planning and design strat- egies that can help EDs manage surge events more effectively: n Incorporate vertical care. One of the most effective strate- gies for reducing patient length of stay and improving patient flow in EDs is the incorporation of vertical care models, such as fast-track and super-track systems. Fast-track units are designed to handle patients with less severe conditions who can be treated quickly and discharged, freeing up resources for more critical cases. Super-track systems extend this concept by streamlining care for patients who require slightly more complex treatments but do not need full ED resources. Empirical studies have consis- tently documented the efficiency and positive impact of these verti- cal care models in reducing surge event overload in EDs. We have observed in real time how our cli- ents who have provided fast-track units have significantly decreased length of stay for eligible patients, reduced waiting times, and improved patient throughput. Additionally, this helped alleviate the burden on health care staff by distributing the patient load more evenly and preventing bottlenecks in care delivery. n Design for doubling up. The availability of flexible space that can accommodate more patients during surge events is crucial for emergency departments. Space constraints often become a bottle- neck, and in extreme situations, hallways may become the only available option for providing care, which compromises patient dignity and privacy. We have seen success by designing ED rooms that allow for double occupancy when needed and have used this approach in a trauma/resuscita- tion room designed to be able to double its capacity during surge events. Such designs ensure that the room can function efficiently during normal operations but can quickly adapt to handle more patients when the need arises. In several projects, we have included additional air and elec- trical outlets in rooms to accom- modate an extra bed during critical times, an affordable and effective strategy. This allows for quick adaptation without signifi- cant structural changes or costs. This approach has been quite suc- Planning & design for surge capacity in ER departments T he acoustic environment of health care facilities can have a significant impact on the health outcomes of patients, staff and visitors. Excessive noise lev- els, poor speech intelligibility, and inadequate sound isolation can negatively affect patient recov- ery, communication between staff and patients and staff well-being. Therefore, it is essential to design health care facilities with care- ful consideration of acoustics to ensure optimal patient outcomes. Excessive noise in health care facilities can have adverse effects on patients, including increased stress levels, higher blood pres- sure and delayed recovery times. The World Health Organization recommends that hospital noise levels not exceed 35 decibels dur- ing the day and 30 decibels at night to promote restful sleep and reduce stress levels. Inadequate sound isolation can result in unwanted sound trans- mission between rooms, which can lead to privacy breaches and decreased speech intelligi- bility. Poor speech intelligibility can negatively affect communica- tion between patients and health care p r o v i d e r s , p o t e n t i a l l y leading to m i s u n d e r - s t a n d i n g s , misdiagnoses and incorrect treatments. In addi- tion, health care provid- ers are at an increased risk of developing occupational hearing loss due to prolonged exposure to high noise levels. Hearing loss can result in difficulty communicating with patients and colleagues, leading to decreased quality of care and potential medical errors. Common design strategies for improved acoustics To optimize acoustics in health care environments, several design strategies can be implemented, including: n Room design. Room dimen- sions and configurations can affect the acoustic properties of a space. A well-designed room can help to reduce noise levels, improve speech intelligibility and provide adequate sound isola- tion. The use of sound-absorbing materials, such as acoustic ceiling tiles, wall panels and flooring, can help to reduce unwanted sound reflections and improve speech intelligibility. n HVAC system. The heating, ventilation and air conditioning system can significantly impact the acoustic environment of a healthcare facility. HVAC noise can contribute to overall noise levels and should be carefully considered during the design phase. Quieter HVAC systems can help to reduce overall noise levels and improve patient com- fort. n Sound masking. Sound masking involves the use of low- level background noise to reduce the impact of unwanted noise. Sound masking can improve patient comfort, privacy and speech intelligibility. It is often used in waiting areas, exam rooms and other spaces where privacy is essential. n Staff training. Health care providers should receive train- ing on the importance of acous- tic design in healthcare environ- ments. Training should include strategies for reducing noise lev- els, improving speech intelligibil- ity and ensuring adequate sound isolation. Staff education can help to create a culture of acoustic awareness and promote optimal patient outcomes. But a lesser-known tactic that can quickly reduce noise? Hospi- tal curtain tracks. Hospital curtains are com- monly used as partitions between beds or in treatment areas, and they can help to reduce noise transmission between spaces. Hospital curtains can also con- tribute to sound isolation, which is crucial in health care settings. By creating a physical barrier between different spaces, hospi- tal curtains can help to prevent the transmission of unwanted sound, thereby protecting patient privacy and reducing the risk of noise-related disturbances. For example, our bendable cubicle track easily bends by hand on-site for simple installation and can accommodate virtually any design. Independent testing has shown significant decibel reduc- tion with our system vs. standard aluminum track, making it the perfect solution for health care spaces. It’s worth noting that hospital curtains and tracks alone may not be sufficient to address all acous- tic issues in health care design. However, when used in conjunc- tion with other acoustic design strategies, hospital curtains can contribute to improving the acoustic environment of health care facilities, leading to better patient outcomes and increased staff satisfaction. By implementing appropriate design strategies like sound-min- imizing cubicle tracks, health care providers can improve the acous- tic environment of their facilities, leading to better patient outcomes and increased staff satisfaction. s bparnell@inprocorp.com Importance of acoustics in health care environments Ali Momen- Heravi, PhD EDAC Health care planner, Page Akshay Sangolli, AIA, ACHA, EDAC, LEED AP BD+C Lead health care planner, based in Page’s Denver office. Acoustics Becky Parnell, CSI, IIDA Territory sales manager, Inpro Please see Momen-Heravi, Page 23 Robert Benson Photography Memorial Hermann - Texas Medical Center, Susan and Fayez Sarofim Pavilion adult trauma rooms have the capacity to double up in mass casualty events – but are usually used as private rooms.