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.
Calculating the Number of General Treatment Spaces
To calculate the number of general treatment spaces, you will need to multiply the expected peak shift workload by the average room time and divide this figure by 480 minutes (eight hours). Patients receiving general care may be placed on a stretcher in a single-patient treatment room or in a multiple-patient treatment area — either in a cubicle (with three walls and a curtain closure) or bay (with a headwall and curtain closure on the remaining three sides). In recent years, healthcare providers have embraced the low-acuity patient treatment station for less acute patients who are placed in a typical chair, lounge chair, or recliner chair appropriate for patient consult and examination. The low-acuity treatment station provides a space-saving alternative to the traditional multiple-patient cubicle or bay, as shown in the figure below.
Identifying Spaces for Specialty Patient Populations
Some of the treatment rooms may need to be designed for special patient populations but can be designed to also serve as general treatment spaces:
- Airborne infection isolation (AII) treatment room. At least one AII treatment room with a contiguous patient toilet room should be located in the ED. Personal protection equipment (PPE) storage must be located either directly outside the room, in an anteroom, or inside the entry door to the room. The AII treatment rooms can be used for non-infectious patients when not in use for isolation.
- Treatment room for individuals of size. All EDs should have at least one treatment room that can accommodate an individual of size. Because this room is larger than a general treatment room, it is commonly designed to be subdivided with cubicle curtains to accommodate two general treatment bays when not in use for an individual of size. A patient toilet room designed/equipped for an individual of size should also be accessible from the treatment room.
- Flexible behavioral health treatment room. Depending on the patient population, one or more single-patient treatment rooms may be designed for flexible use as a general treatment room, treatment room for patients with behavioral health issues, or a secure holding room.
Adding Unique Spaces
Finally, you will need to add other unique spaces such as the following:
- Trauma/resuscitation rooms or bays. Two spaces are typically provided to accommodate patients in immediate need of care or resuscitation. High-volume EDs may require three spaces, and low-volume services may have only one. Patients may be treated in single-patient trauma/resuscitation rooms or in a multiple-patient trauma/resuscitation room with individual patient bays separated by curtains. Because these spaces must be held for patients arriving by ambulance in need of immediate care, they are not typically counted as part of the emergency ED’s required patient treatment spaces. However, a single-patient trauma/resuscitation room can be designed to treat an individual of size or two less acute patients when not in use.
- Secure holding room. At least one secure holding room, designed to prevent self-harm, should be provided to temporarily hold patients in a secure environment until they are ready for treatment or transfer to another facility.
- Human decontamination room. All newly constructed EDs should have a room for human decontamination and hygiene. The room requires an outside entry door and an internal door that opens into an emergency department corridor.
Other Dedicated Specialty Treatment Spaces
The decision to plan dedicated specialty treatment spaces will depend on the expected patient population and related workload. For example, a pediatric treatment area may include a dedicated pediatric trauma room and child-friendly treatment rooms. Some hospitals also provide a dedicated sexual assault forensic exam room with a pelvic exam table, a private toilet room/shower room, and lockable storage for forensic collection kits, laboratory supplies, and equipment. To optimize flexibility, specialty care should be provided in general treatment rooms using mobile carts that can be pulled into rooms when needed. For example, dedicated carts may be assembled for orthopedics/casting, wound care, dental, ophthalmology, pediatrics, or gynecology. Alternately, a general treatment room may be equipped with a specialty chair or exam table, depending on the need.
Determining the Number of Observation Spaces
Patients moved to an observation unit within the ED may be accommodated in single-patient observation rooms or multiple-patient observation cubicles/bays. The number of patient care spaces should be based on the expected percentage of the peak-shift visits that will result in admission and the estimated average time each patient would be held in the observation unit before being moved to an inpatient bed. However, patients held for observation and later discharged must also be considered.
Flexibility is Key
Patient treatment spaces should be designed to optimize flexibility. For example, some treatment rooms can be grouped into a self-contained airborne infection isolation pod using life safety compartmentalization. Acuity-adaptable treatment rooms can provide additional flexibility. A single-patient treatment room can be designed to accommodate a single high-acuity patient or two stretchers or three recliner chairs when necessary. At the same time, a trauma/resuscitation room can be designed to treat an individual of size or two less-acute patients.
More detailed information can be found in the SpaceMed Guide.