Facility Planning – Emergency Room

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Introduction

This paper will highlight the value of facility planning for the renovation of an Emergency Room. It will touch on the regulations, equipment, design, budget, color selection implications and noise issues and the need to involve stakeholders to realize a fully equipped and utilized Emergency Room(ER). The stakeholders include the board memembers, administrators, shareholders, patient representatives, architects, and doctors. The most efficient emergency rooms to the day will be those that involve all stakeholders in their creation, renovation, and policy implementation (Anthony & Watkins, 2002).

Purpose

The focus will be on the renovation of the Emergency Room at Anaheim Memorial Medical Center, California. A $3 million worth of renovation has been set aside to expand the emergency center at the hospital to accommodate the rising number of patients in need of emergency services. The renovation at Anaheim began in April 2011 and is focusing on emergency room expansion, facelift, and equipment upgrades. Common reasons for visits to the Anaheim emergency room include diseases and conditions that threaten life such as severe asthma attacks, seriously broken limbs, sprains, eye injuries, chest pain, cardiopulmonary arrest, trauma, and stroke.

Regulatory requirements on the design and equipment

The first stage in the design and equipment of Anaheim Memorial Medical Center was to identify the needs of stakeholders and satisfy them in the best way. Certification and regulatory requirements before the design phase of an ER can reduce the cost of equipment, enhance safety, and hasten certification and completion of projects. The Construction Safety Act and the Emergency Planning and Community Right-to-Know Act ensured that the community was aware of the emergency room renovations at Anaheim Memorial Medical Center. Certificate of Need (CON) was given after the local authority agreed there was a need to renovate the ER facility. Compliance with the minimum requirements of the Disabilities Act ensured that all areas, both in and outside the ER could and be comfortably used by many patients with temporary or permanent handicaps. The Joint Commission on American Hospital Organization (JCAHO) has also agreed to vet the new and existing personnel to meet minimum working standards at the health facility. Any person hired for the renovation work was verified to be insured, bonded, and licensed. The use of medicines, chemicals, medical equipment, and how to renovate the ER without closing it also met all safety regulations. The ER continued to comply with the Emergency Medical Treatment & Labor Act (EMTALA) of ensuring public access to emergency services regardless of their ability to pay. The Agency for Healthcare Administration has been invited to assess the ER renovation and has so far come twice and approved the progress. These are among the USA regulatory requirements that ensure that ERs are renovated with the patients’ safety and comfort as a priority (Lee, 2000).

Color selection implications and noise issues

Using, color, artwork, and aesthetics can enhance the soothing and calming qualities in patients. According to the Alzheimer’s Association, patients seem to remember colors better than numbers (Marcus & Barnes, 1999). Warm colors like red and orange are attributed to awakening anxiety and excitement. Green, considered a cool color, is said to make one feel relaxed and calm. At Anaheim Memorial Medical Center, the pediatric rooms at the ER have bright mixed colors of orange, yellow, and brilliant green. Colorful artwork is being added to appeal to the children and the exam rooms have different colors to act as a diversion for different types of patients.

Equipment clatter, noisy public address systems, and conversations at nurse stations slowed the healing process. Reduction or elimination of sources of noise from other patients, and playing of mellow recorded music in patients’ room was found to create a healing environment. Acoustical treatment of corridors along with patient rooms with carpet tiles, rubber flooring, and acoustical separation of staff work areas from patient rooms can enhance the healing process. “Even low noise levels (40-58 dB) combined with poor acoustics can reduce sleep quality and negatively affect other outcomes” (Ulrich, 2003).

Equipment needed in the renovation

Medical equipment was highly regulated and their level of safety is a matter of life and death. Certain types of medical equipment function as life support machines and their failure could result in the death of a patient (Malkin, 1992). While renovating, the medical equipment purchased for the ER included transport stretchers, wheeled gurneys, foldable stretchers, oxygen tubing, tank holders, and nasal cannulas. Pediatric nebulizers and smaller-sized blood pressure cuffs were bought as child-friendly accessories. Folding medical examination tables, rolling physician stools, portable dental chairs, medical gloves, cotton tip applicators, glucometers with strips, and manual blood pressure cuffs were also bought. Common items like fire blankets, antibiotic ointments, and band-aids among many others should never be overlooked.

Electronic items needed

While renovating the ER, the electronic items needed will include newer versions of electronic blood pressure machines, electronic medical record (EMR) system electrostatic air filters, EKG machine ( electrocardiogram}, x-ray aprons, dental digital x-ray units, lasers electronic timers, USB microscopy camera, electroencephalography equipment, electrosurgical units, and LCD monitors to complement the existing ones.

Examination of budget planning and cost estimates

In April 2011, $3 million was set aside for the renovation, expansion, and equipment upgrade at Anaheim Memorial Medical Center, California. The aim is to accommodate the rising number of patients needing emergency services. The renovation is projected to end in early June 2011. The project was broken up into four phases to allow continuity of service in the ER.

The first and second phases of creating new extra space for a new pediatric emergency suite, gynecological examination rooms, and space for the admission of patients arriving via ambulance will cost about $1.2 million. The third and the fourth phase will involve painting and coloring of the various suites and purchase of equipment which may cost not more than $1.8 million. About 4,500 square feet will have been added or renovated by June 13, 2011. The accountants have already budgeted from revenue collected from patients, donations, and a loan taken from the bank. They have also established the cost of renovation in each department, cost of all personnel, and purchase price of diagnostic equipment (Kaplan & Arbor, 2005).

Role of stakeholders in facility planning and development

Within any business or health care organization, there is a need to use strategic planning, this consists of mapping out the objective, idea, and purpose for a project. Stakeholders consist of board members, administrators, architects, interior designers, shareholders, and doctors. The responsibility of core stakeholders is to ensure the presence of quality training of personnel, use of latest knowledge, modern equipment and technology. They also oversee infrastructure, logistics and provision of mutual support in all projects. Stakeholders today are using strategic planning in mapping out the objective, idea, and purpose of any project in the ER (Bristol, 1995).

Gantt chart that details an implementation plan

A Gantt chart shows the tasks of a project, when and how long each will take. Bars are shaded to show, which tasks have been completed and who was assigned particular tasks (Clark, 1952).It also determines the resources needed. Below is a Gantt chart that details implementation plans of a new Emergency Room.

Conclusion

To have the emergency rooms perform their functions effectively and efficiently there must be significant input in facility planning from stakeholders from the onset. It takes committed social, technical and legal consultations to renovate a worthy ER. The successful renovation at Anaheim Memorial Medical Center will require strict budgeting and a substantial amount of money. Facility planning and consultation among stakeholders is cost effective as it reduces the need for frequent renovations and upgrading of emergency rooms.

References

Anthony, K and Watkins, N (2002) Exploring Pathology: Relationships between Clinical And Environmental Psychology. New York: John Wiley & Sons

Bristol, D (1995) Mental Health and the Built Environment: More than bricks and mortar. London: Taylor & Francis Ltd., 1995.

Clark, W (1952). The Gantt Chart. London: Pitman

Kaplan, R and Arbor, A (2005) Humanscape: Environments for People. New York: Ulrich’s Books, Inc.

Lee, M (2000) Reducing noise pollution in the hospital setting by establishing a department of sound: a survey of recent research on the effects of noise and Music in health care. Preventative Medicine, Volume 30, Number 4

Malkin, J (1992) Hospital Interior Architecture: Creating Healing Environments for Special Patient Populations. New York: John Wiley & Sons, Inc.

Marcus, C and Barnes, M (1999) Healing gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley & Sons, Inc.

Ulrich, R (1992) How Design Impacts Wellness. Healthcare Forum Journal, 16-19

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