The American Institute of Architects

Alleviating crowding and minimizing length of stay continue to be major issues in the Emergency Department. However, when intake and flow in the ED are examined, it is clear that the issue is multi-faceted; it will take a combination of improving proximities, changing the care paradigm, and operational changes to improve the conditions There have been numerous studies related to operational performance of the ED and the design of the room itself, however, few delve into the issue of the relationship of staff to patient from a design point of view. This study examines ED design from the point of view of staff delivery of care, using several case studies. The case studies represent the evolution of a design concept, where data learned through postoccupancy evaluation was then applied to the subsequent design. What resulted was the “Ribbon” ED concept, which focusses on improving efficiency and flow through a decentralized design that can easily flex based on patient load while minimizing the staff needed to care for patients. The improvement factors achieved in this concept can be combined with other operational and design improvements for other areas of the ED to produce a concept that can be customized to future ED design based upon size and volume targets.