Emergency

Emergency care services are often the initial gateway for many individuals into a health system. For most institutions, the emergency department serves as a primary source of inpatient admissions (ranging anywhere from 20% to 55%) and generates a significant amount of ancillary and follow-up services. Emergency facilities are undergoing dramatic changes in response to market, customer and technological requirements. Some of the major influences include:

Observation Centers: Emergency centers are incorporating full scale Observation Centers to respond to new APG reimbursement requirements; to consolidate monitored and "holding" patients and to market specialty services such as Cardiac Centers. Observation Centers are helpful to remove longer-term patients from occupying beds in the mainstream treatment zones, which rely on quick turnovers to maximize operational efficiencies.

Environment: The traditional emergency department is organized around clinical efficiencies and clear patient-to-staff observation. Most departments are characterized by tight, impersonal waiting areas, open treatment cubicles that provide no sense of patient privacy, hallways cluttered with equipment and an environment "littered" with overpowering noise, light and smells. The "M.A.S.H.-like" environment, while clinically effective, increases patient and family anxieties. With many families, the emergency department is the first contact with a health system and their first impression of that system is influenced by their experience in the emergency department.

Technology: The use of high-tech diagnostic modalities such as CT and MRI have replaced more traditional film-based imaging and, in some cases, laboratory procedures. Once only located in central laboratories and Radiology departments, CT scanners, MRI and Stat labs are common program components within emergency departments.

Information and Communication: The "blood flow" of an emergency department is the patient file. With the introduction of electronic medical records and the use of hand-held equipment, the classic "centralized" organizational model is being replaced with decentralized "zone" organization, which reduces patient transfer, staff circulation and increases patient response times.

Physician in Triage (PIT): Creating a bank of low acuity patient stations and providing a physician in the triage can alleviate a large burden on the department by immediately deterring patients whose condition does not require emergency care. PIT has seen reductions in nearly 30-40% non-required admissions to the ED.

Current Trends

With national healthcare legislation and the current economic downturn, hospitals more than ever need to scrutinize every capital dollar spent on their facilities. Architects and healthcare facility planners must be aggressive partners in this process by making sure that the facilities are "right-sized". This translates into the need for designs that are responsive to current and future needs, and at the same time responsible in their size and cost.

Trinity Health Group has focused their practice on helping health organizations make good business decisions to maximize the use of their facilities and the return on every dollar spent. With statistically driven analysis and responsible designs, Trinity has helped hospitals trim waste, spatially and fiscally. Emergency department planning is a service area where Trinity has had great results.

Emergency departments have a highly predictable flow of several processes, which are interrelated to each other. Increased throughput for an emergency department is critical to both increased patient satisfaction, and hospital profitability. Operational efficiencies can also help reduce space, reduce costs, and ultimately yield a better return on investment. By incorporating appropriate operational changes, Trinity can help increase productivity, while reducing actual square footage. Some of these changes might include:

  1. Quick Registration with subsequent bedside registration
  2. Physician in Triage layout
  3. Computer Provider Order Entry
  4. Patient Tracker Systems
  5. PACS
  6. Instant Hands Free Voice Communication System
  7. RFID-Radio Frequency ID System (a large percentage of a nurse's time is spent "hunting and gathering")

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