Rocky Mount, North Carolina
Little
Charlotte, North Carolina
Keith C. Fleming, AIA, LEED AP, Director of Healthcare Planning
Larry H. Chewning, CEO, Nash General Hospital
Opened January 2014

Key Words
Operational efficiency
Patient/staff satisfaction
Space issues

Problem/Situation

As one of the busiest emergency departments (ED) in North Carolina, the existing ED at Nash General Hospital faced multiple challenges because of its age, proximity to other compatible departments, and its visibility to visitors. Constructed in the 1980s, the facility had undergone multiple renovations in an attempt to accommodate increasing patient volumes but lacked a comprehensive patient experience. The structure was located at the rear of the campus and landlocked between a large retention pond, the existing hospital bed tower, and an existing parking deck. These site challenges not only made it difficult for visitors to find and access this critical service line but also secluded the ED’s access to other compatible departments often necessary with an emergency visit. (See Existing Site Plan)

Solution

The solution was to construct a new 52,400-sf ED and relocate it to the opposite side of campus, allowing the existing ED to continue to operate for the duration of construction without disruption. (See Proposed Site Plan.) Sized to accommodate 82,000 visits annually, the new emergency department features 45 exam rooms, a 5-bay rapid treatment area, a 6-bed clinical decision unit, a 6-bed psych holding area, 5 triage rooms, and 4 trauma rooms. The site of the new ED allows the entry to be clearly visible from the main campus entry drive and the adjacent highway and is close to other departments. Utilizing an area previously used as underground parking, the new ED is directly below the existing surgery department and a new heart center and adjacent to the existing ORs. This physical connectivity of emergency services, surgical services, and cardiac services allows critical patients to be transported between these departments with ease and minimal travel time.

The design solution also included a new helipad adjacent to the ambulance dock, eliminating the existing need for an ambulance transport between the pad and the ED.

While building below the existing surgical services department in space that was previously underground parking was particularly challenging, the new design provided a much improved patient and staff experience. From an operational standpoint, the new design allowed the department to grow from 24 to 62 treatment spaces.

Functionally, the new design separated the pediatric treatment and waiting space from the adult treatment and waiting space. Additionally, a 6-bed secure psych holding area was created to facilitate ED exam room turnover The 6-bed clinical decision unit, a 4-bed rapid treatment unit, and a 7-bed fast track area all function as “swing spaces” with the adult treatment area, allowing the department to flex in response to varying patient volumes throughout the day.

Lessons Learned

• Three-dimensional models are helpful, but nothing is more beneficial than an actual physical mockup of key spaces. This approach can be used to quickly identify and resolve functional problems while providing additional opportunities for staff participation and buy-in on the final design.
• The existing ED was not impacted at all during the course of construction. Any time a replacement facility can be accomplished for a critical department instead of a “renovate in place solution” it is advisable to do so.
• Equipment decisions made early in the design process can change during the course of construction. Don’t design spaces to be too “tight.” Allow room for future flexibility as well as changes in owner-provided equipment.
• Include a patient lift in the decontamination/disaster response area.
• With this project, a nursing consultant came on board late in the design process, which caused some changes in the plans to the benefit of the project; however, it would have been much better to have all consultants in place early in the design process to avoid reworking the plan late in the game.
• The client and patients have been very happy with the new location of the ED. Its highly visible location off the main campus entry drive has been very well received. And the new proximity to surgical services and the heart center has proven to be a plus for patient care and transport.

Editorial Commentary

This is a new ED with separate adult and pediatric parts. And it has a 6-bed mental health unit along with a separate critical decision unit. It is characterized by a main adult ED that has a central nurses’ station with 6 fingers of 4 patient beds that spoke out from the central nurses’ station. Most rooms are not directly visible from the nurses’ stations. All patient rooms are universal in size except the trauma and resuscitation rooms. 

Existing Site Plan

Proposed Site Plan

 

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