UnityPoint Health, Trinity, Emergency Department
Rock Island, Illinois
CannonDesign
Chicago, Illinois
Manuel Hernandez, MD, MBA, FACEP, Principal, CannonDesign
Ginger Renkiewicz, Chief Nursing Executive, UnityPoint Health, Trinity
Opened April 2015

Key Words
Space issues
Operation efficiency
Patient/staff satisfaction
Behavioral

Problem/Situation

UnityPoint, Trinity’s former ED, a Level II trauma center, was undersized to meet existing demand and not designed to support current models of emergency care. Future state volume projections indicated the ED could expect annual volume to increase by 20% — from 33,287 patients in 2010 to 45,187 in 2020 — with 12% of total visits coming from behavioral health patients. Given this expected increase in utilization, the hospital needed to increase capacity, expedite patient throughput, and address a number of problems with patient and staff flow (e.g., imaging in the existing ED was centralized and not convenient for users). As an added complication, the hospital, which houses a sizeable inpatient behavioral health program, was projecting a significant increase in the volume and acuity of behavioral health patients tied to the closure of nearby state psychiatric hospitals.

Solution

In the new 31,720-sf UnityPoint, Trinity ED, opened in April 2015, walk-in patients are met by a clinical greeter in the arrival area, supporting intuitive wayfinding. Close proximity to treatment stations supports “direct bedding,” with triage performed at the bedside. During peak volume periods, triage is performed in pass-through triage stations that provide direct access to treatment stations.

Advanced triage protocols are intended to accelerate diagnostics and reduce overall length of stay. To enhance efficiency, imaging services are decentralized and placed closest to the areas of greatest demand (e.g., CT near trauma, X-ray near triage). Additionally, a care initiation area, comprised of lounge chair stations, is designed to station low-to-moderate acuity ambulatory patients awaiting diagnostics or disposition (see image 1).

In the 22-room main ED, universally configured, standardized treatment stations utilizing mobile supply carts support care for any patient in any room (see image 2), excluding the trauma resuscitation room and negative pressure ventilation treatment stations. Three treatment stations are outfitted with additional security measures to facilitate rapid conversion to behavioral health safe treatment stations (see image 3). In addition, subwaiting areas provide comfortable space for visitors who need to temporarily step out of a treatment station.

Decentralized staff workstations reduce staff travel distance and promote direct line of sight to all treatment stations. Subwaiting areas provide comfortable space for visitors who need to temporarily step out of a treatment station.

Through a collaborative medical clearance process, medically stable behavioral health patients can receive their medical screening in the crisis stabilization unit directly adjacent to the ED. This allows for more rapid disposition of behavioral health patients while providing an environment free of the ED milieu that can trigger behavioral escalation.

Within the 6-room crisis stabilization unit, the “living room” provides a relaxing and noninstitutional environment for medically stable behavioral health patients not requiring de-escalation or administration of psychotropic medications (see image 4). Located within the locked zone of the unit, this environment is adjacent to behavioral health treatment stations and in direct line of sight of staff work zones.

Supporting the reduction of potentially avoidable admissions and accelerating throughput, a 12-bed clinical decision (observation) unit is immediately adjacent to, but physically distinct from, the main ED. This facilitates clinical oversight of the unit by emergency medicine but in a more private and quiet environment.

Lessons Learned

• Engagement of an interdisciplinary team of clinical providers early in the design process provided the opportunity to thoroughly explore how innovations in the model of care and corresponding changes to patient flows, processes, staffing, and use of clinical and information technologies will evolve in the future. This supported the development of a design that was a significant departure from the previous emergency department environment.
• Decentralizing imaging services with each modality placed closest to its area of greatest demand (e.g., CT near trauma, X-ray near triage) allows for better patient throughput and shorter travel distances.
• Providing dedicated environments for behavioral health patients within the geographic confines of the emergency department provides a more efficient and patient-centric experience for all patients while promoting the dignity of the behavioral health patients.

Editorial Commentary

This is a new ED characterized by a podular design that breaks the ED up into 4 separate parts, including a separate observation area, results/inner-waiting area, and a mental health unit. The patient rooms are universal in design. And there is a combination of distributed and central nursing staff work places.

 

Image 1

 

Image 2

 

Image 3

 

Image 4

 

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