Every hospital emergency department (ED) is different because it reflects the community’s needs and resources. Some hospitals offer the full continuum of emergency services — including trauma and emergent care, nonurgent care, an observation unit, a chest pain unit, pediatric services, and a behavioral health crisis unit — while others provide only basic services. To estimate the numbers and types of ED treatment spaces, you first need to calculate the number of general treatment spaces (for both the emergent/urgent care area and nonurgent/fast track area). Some of these spaces can then be designed for use by special patient populations. Finally, you need to add other unique and specialty treatment spaces to arrive at the total number of patient care spaces to be planned.
Impact of the Pandemic on Healthcare Facility Planning
Hospitals and healthcare systems have spent much of the last three years balancing being in a state of emergency readiness while waiting for the next COVID-19 wave and safely delivering routine health services. Many of the challenges that existed before — a shrinking workforce, an aging infrastructure, and narrow operating margins — have worsened during the pandemic. At the onset of the global pandemic, faced with rising COVID admissions, many hospitals canceled elective procedures and redeployed patient care space in new ways to meet the rising demand for beds and new infection control measures. At the same time, U.S. adults delayed or avoided medical care due to their coronavirus-related concerns causing non-COVID admissions to plummet. Starting the third year of the global pandemic, staffing shortages due to burnout were at an all-time high as hospitals still struggled with COVID-19 admissions while treating higher-acuity patients. Hospitals and health systems continue to face increasing costs for labor, drugs, personal protective equipment (PPE), and other medical supplies needed to care for higher-acuity patients.
According to the American Hospital Association (AHA), America’s hospitals are experiencing unprecedented financial losses — 2022 was the most financially difficult year for hospitals and health systems since the start of the pandemic, leaving over half of hospitals operating at a financial loss at the end of 2022, and with negative operating margins continuing into 2023. As a result, healthcare organizations are rethinking their capital investments while existing facilities are being retooled, expanded, and underutilized simultaneously. In this post, you can read about some of the current issues in healthcare facility planning — fluctuating utilization and forecasting challenges, shortage of nurses, new safety protocols, rapid growth in telemedicine, advances in telecommunications technology, and integration of imaging into most medical specialties.
Nursing Unit Space Per Bed Can Vary Significantly
Have you ever wondered why there is significant variation in the nursing unit space per bed from project to project? Particularly when the number of beds is the same. Historically, this variation was attributed to the mix of private, semiprivate, and multiple-bed patient rooms. However, even today when most hospital building projects in the U.S. have all private patient rooms, the nursing unit space per bed continues to vary. Contributing factors include the size and layout of the private patient room and adjoining toilet/shower room, the specific grouping of the patient rooms within the unit, and the overall design and layout of the floor itself. The amount of family, visitor, and staff amenities provided on the floor and the extent of point-of-care clinical and support services are also factors.
Why Facility Master Plans Are Shelved
A shelf full of outdated facility master plans used to be a common sight in the facility manager’s office of a large medical center. These are often very thick documents with beautiful graphics that explain in great detail the phased stages of a multi-year building project. There are many reasons why these plans may not have been implemented but the planning process itself is a major factor.
Confusing Net and Gross Square Feet Can be Disastrous
Frequent misunderstandings arise when hospital leaders, department staff, planners, and architects confuse net square feet with gross square feet (or net square meters and gross square meters). It is particularly disturbing when facility planners and architects simply specify “square feet” in their documents.
How Many ORs? It’s Complicated
Planning a surgery suite used to be fairly simple. General operating rooms (ORs) were used for a wide range of procedures and dedicated operating rooms were limited to cardiac surgery and orthopedics. At the same time, interventional radiologists and cardiologists created their own workplaces. Today, planning surgical and endovascular suites is complicated by the convergence of diagnostic imaging and surgical procedures, rapidly changing technology, increasing specialization, and strict distinctions between operating rooms and procedure rooms. From a facility planning perspective, the number, size, and specialization of ORs and endovascular procedure rooms is the single most significant factor contributing to the overall footprint of the suite (and project cost). Moreover, the numbers and sizes of related patient care and support spaces are driven by the number and types of operating/procedure rooms. More importantly, the number of operating/procedure rooms drives ongoing staffing and related operational costs.