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The physical environment of the emergency department (ED) is critical to the efficient and safe operation of the service. The abilities to move patients efficiently, to provide appropriate staff work and support spaces, and to ensure the ability to respond to critical “events” require the right space elements and configuration. This chapter will focus on methods to translate care needs into projected space and into a functional emergency design. Each emergency service is a unique blend of patients, processes, and institutional characteristics. Successful planning requires a logical framework for analysis along with the commitment of ED leaders to the time and effort required to achieve a successful design.

The projection of future demands systems of care delivery and service requirements for emergency care is a daunting challenge. Designing for flexibility to accommodate new care models that may be radically different than today's system is critical. Too tight of a “goodness of fit” between anticipated operational patterns and the design solution could create a high-risk situation by limiting the life of the building. Designing with flexibility maximizes the “sweet spot” between best estimates of needs and requirements of future emergency care delivery.

The determination of space needs and development of a design solution is typically divided into 5 steps (Box 25-1).

Box 25-1 The 5 Steps of Space Determination


  • Strategic and operational planning: The development of a mission statement for the ED design, projection of target workloads, patient mix, and the identification of a desired patient processing and operation plan, consistent with the present and future mission of the hospital.
  • Process planning and modeling: Determining the needs for areas including adult, pediatric, trauma, mental health, observation, and specialty needs (cardiac intervention, SAFE, orthopedic, etc).
  • Functional and space programming: Conversion of the strategic projections and process models into specific space elements. The product of this phase of work includes a listing of all the space elements, diagrams illustrating the grouping and relationship of space elements, and the key relationships to other services, such as imaging, surgery, intensive care, and other inpatient units.

Design Phase

  • Schematics: Early translation of the functional and space program into layouts of the department showing the physical organizational concepts, site access and circulation, and budget estimates. Alternative schematic designs are frequently developed and evaluated. This phase moves from simple “bubble” diagrams of areas into “single-line” drawings showing the approximate scale and relationship of elements (Figure 25-1).
  • Design development: Refinement of the preferred schematic design showing wall thicknesses, structural grid layouts, door and window locations, and placement of major fixed equipment (eg, sinks, headwall units, imaging equipment, etc). The initial development of interior design concepts ...

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