This is a continuing series from Huddy HealthCare Solution’s ED Design Team that covers “issues to consider” in support of making your next ED design project a success.
Review from Last Week
In last week’s article, Design Your ED to Operate Efficiently and Safely Over 24 Hours, we emphasized the relationship between an emergency department’s Walk-In Entrance and the EMS Entrance. In summary, while you don’t want these entrances right next to each other, you also don’t want them at complete opposite ends of the department that force you to staff two completely separate locations in the middle of the night. You want to design the EMS entrance in a location that allows immediate access to centralized Resuscitation Rooms allowing any team in the ED to cover these “major” rooms at any time of day.
Location Location Location
This week we discuss the location of a Behavioral Health Suite in your ED and how the right location will support a safer environment. Like real-estate people like to say, the three most important considerations for purchasing a property are “location, location and location.” The same can be said for Behavioral Health Suite design. When determining how you are going to integrate a Behavioral Health Suite into your ED design, you need to first consider access to the Behavioral area from both the Walk-In Entrance and the EMS Entrance. You should place the Behavioral Health Suite in a location that allows immediate access from both of these entry points thus minimizing the mixing of psychiatric patients with your other ED patients and families.
As noted in Diagram A below, the Behavioral Health Suite (Zone A, lower right) can be accessed immediately from the EMS Entrance (right/center) and the Walk-In Entrance (bottom/center). You should also note on the diagram that the Security Office is located in an area that allows visual supervision of the main Public Walk-In Area, but also has direct access into the Behavioral Health suite through a backdoor. This location for Security allows security staff to access the Behavioral Health Suite without having to transverse the public waiting room.
Many of the emergency department physicians and nurses that I have had the opportunity to work with over the past 25 years have requested that there “only be one entrance/exit to Behavioral Health to limit patient elopements.” I understand their concerns completely. However, I like to work with them to understand how having two entrances/exits means that there will never be a dead-end corridor in the unit where staff may get trapped by patients. There are door locking mechanisms that can be integrated into your design that can keep behavioral patients secured in a unit while still allowing rapid escape by staff when necessary. Always design your Behavioral Health Suite with a minimum of two entrances/exits to support a more safe and secure environment.
Separated But Not Isolated
While there are many more issues to consider with regards to Behavioral Health Suite design (that would take 20 more pages to document), the final issue that I would like to cover in this article is the level of separation of the Behavioral Health patients and staff. Most clients ask for the Behavioral Health patients to have maximum separation from the main ED patients, with the intent of limiting the “disruption” that these patients can bring to the general ED clinical area. I support the need to separate the psychiatric patients for the same reason, but I believe that you can minimize “auditory” disruption while still maintaining a visual contact between Behavioral Health care teams and other care teams in the main ED. By use of sound-deadening safety glass, you can develop a Behavioral Suite that is sound isolated while still maintaining a visual connection to other care teams. If you look back at Diagram A, you will note that while Zone A Behavioral Health is separated, it still maintains a visual connection to a Central Control area (where a Charge Nurse, unit clerk, radios, etc. may be stationed) and a visual connection to the clinical team in Zone B (upper right).
Your future ED design should make sure that a Behavioral Health clinical team is never isolated without visual connection to other teams. If a violent “event” occurs in the Behavioral area, security staff and other clinical staff should be able to immediately visualize what is occurring and offer the appropriate assistance as dictated by your protocols for such situations.
If you would like more insights on ED design please contact Jon Huddy at firstname.lastname@example.org