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Always Looking Ahead: ER Space Planning

Always Looking Ahead:

Emergency Room Space Planning for Improved Patient Flow

 By Joe Middleton, Vice President of Healthcare Services


Nationally, visits to emergency departments have increased at an average annual rate of two percent, and many new EDs have reported an additional five to ten percent jump in visits at the opening of a new [hospital] facility (1). This increase in patient volumes can lead to overcrowding, which ultimately has a negative effect on hospital staff efficiency, quality of care, and patient flow and satisfaction. To better accommodate this influx of patients, many hospitals look to expand their existing emergency room or reconfigure existing space, which can be challenging due to their duration, cost, and effect on hospital operations; and, if not properly planned, can lead to spaces that do not meet your needs. However, those challenges can be minimized by proper space planning exercises on the front end of concept development.



One of the most crucial components of space planning is to make sure that your hospital leadership and your selected design and construction firms thoroughly analyze the current ER traffic and volume during peak periods (including any fluctuations and unique cycles of days and weeks throughout the year). Accounting for your maximum traffic, not just your average, gives a more accurate estimate of current, as well as future, space needs. Queuing studies and demographic/population data (historical, present, and future) should also be reviewed. For example, is the surrounding community primarily a retirement/aging population, indicating the need to address unique geriatric needs outside of the ER in a separate facility? Or is the geographic area primarily young families with children, possibly influencing a greater need for a dedicated emergency pediatric treatment area? This analysis can be further enhanced if you engage the services of a third-party healthcare facilities program manager, as they can assist you in identifying and accommodating these trends and needs that may affect the resulting project design.



Since different ER stakeholders view design and space planning needs differently (i.e. physicians focus on room configuration, but nurses focus on line of sight to patients and monitors), it is essential to understand the necessities, requests, goals, and functions of diverse hospital staff groups who will be using it. To gain this critical insight, I recommend creating an Executive Oversight Team made up of representatives from senior management, doctors, nurses, ancillary staff, and the hospital’s project and/or facility managers. This team then works collaboratively with the design team at the forefront of a project to provide feedback and discuss anticipated needs to help shape the project design. Stakeholder input helps reveal deficiencies in the design much earlier on, which means less chance for change orders and re-designs further down the road. We’ve found that a 10% increase in design time works out much better budget and schedule-wise than a 10% increase in construction time, so be sure to make the time to get staff input first.



Instead of feeling like you need to re-invent the wheel for every project planning process, follow the lead of other healthcare facilities that were successful at creating optimal patient flow for new space. Plenty of case studies exist online about emergency room redesigns that illustrate workable possibilities, such as eliminating large registration areas in favor of bedside registration to allow clinicians access to the patient as quickly as possible, or reconfiguring triage and managing low acuity care patients by quickly moving them into spaces where nurses can assess their condition and provide minor treatments. Attending conferences with your peers and touring non-competing hospitals are other ways you can be an active investigator.


Observe & Incorporate

Another key facet of space planning is for vital hospital personnel and design/construction project team members to first observe clinician work flow and then integrate those observations into the plan. This step not only helps to confirm and build upon the feedback that you receive from the Executive Oversight Team, but also identifies any inefficiency that may have been missed during those discussions. Take time to interview patients and their families about their experience, as well as local police, fire, and other first responders who use the space during high-pressure times – they can give outside viewpoints about increasing efficiency in some areas that may not have been thought of before. We also recommend you engage your design team and your selected construction firm to budget for and build a full-scale mockup of a trauma room or satellite imaging suite during preconstruction. It provides hospital staff the opportunity to “test drive” specific areas so they can point out what needs improvement and you can ensure your comfort level with finish, durability, and installation. It also encourages collaboration between the design and construction team to develop clearly prioritized design solutions earlier, which can save time and money during construction.


The continuous change and growth in healthcare services is driving a patient increase in many areas, particularly in emergency rooms, which in turn drives hospitals to further improve access to care by expanding their emergency departments. To best respond to this challenge and construct ER spaces that are both functional and effective for patients and staff, early engagement and input from designers, programmers, constructors, and a variety of hospital stakeholders during the space planning process is vital. If done well, space planning can ensure that projects add more than just rooms and square footage – it can improve the care experience for patients and staff and create spaces that are functional, efficient, and allow for flexibility and longevity.



1. Zilm, Frank. “Designing for Emergencies.” Health Facilities Management. American Hospital Association, November 1, 2010.




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