ED Facility Design and Informatics. Disclosure Information. Stock Ownership Forerun. Objectives. A Must Have Book. Estimating Treatment Spaces

Transcription

1 ED Facility Design and Informatics Cambridge Health Alliance Harvard Medical School Cambridge, MA Disclosure Information Stock Ownership Forerun Objectives A Must Have Book! Review planning considerations for building a new ED! Review essential components of ED information systems! Discuss examples of ED floor plans Pre-construction planning Estimating Treatment Spaces! Selecting architectural & design teams! Needs assessment & planning! Estimating treatment bed needs! Departmental construction & layout! Building codes ACEP: Emergency Department Design, A Practical Guide to Planning for the Future 1

2 Mapping Flow ED Layouts Zilm, F Emergency Department Floor Plan Elevators Observation Unit Non-Acute Fast Track Acute Area Psychiatric Emergency Radiology Waiting Area Reception Triage Trauma Resuscitation Bays Main ED Patient Entrance Ambulance Parking Decontamination Room Registration! Workstations! Payment collection! Supplies, cabinets, storage! Integrate with triage & patient care areas 2

3 What To Avoid Triage! Decrease time to see doctor! Pre-registration, kiosks, bedside registration! Decrease time to treatment, radiology & laboratory! Nursing protocols, draw labs! Supplies, work area! Chair, examination table, stretcher! Safety, infectious disease Universal rooms! Limit specialization! Study response to critical events! Cart-based supplies! Specialty considerations! Difficult integration: dental, ENT, pediatrics! Possible integration: OB/Gyn, orthopedics, sexual assault, psychiatric facilities.uchicago.edu, Patient care areas! Access to patients right side! Maximize staff efficiency! Patient comfort! Entertainment! Natural light, temp control! Family comfort, involvement! Patient privacy! Visibility

4 What To Avoid Clinical support! Medication storage! Nourishment! Environmental support! Radiology viewing & storage! ED laboratory! Clean & soiled utility! Clean & soiled linen supply Operational Work environment! Point-of-care testing! Observation, respiratory, fasttrack integration! Patient satisfaction! Re-evaluation by RN, techs! Reading materials, entertainment! Separate staff and patient flow! Charting area! Break & education room! Lockers and showers! Reference materials! Noise! Office space! Sleep room 4

5 What To Avoid Technology ED Information Systems! Self-registration, pre-registration! ED Information systems! Data gathering, performance goals & expectations! Communication & radio room! Security, monitoring! One size does not fit all! Academic vs community! High vs low volume! High vs low acuity! 1:1 nursing or zone coverage! 5 traditional ED IS functions:! Triage! Tracking! Order entry & medication management! Charting! Discharge 5

6 Triage Triage! Allows capture of! Limited demographics! Vitals! Chief Complaint! Medications, Allergies! Care providers! Advantages! Data accuracy is best in real time! Drives other processes! Puts patient on tracking system! Populates electronic templates! Allergy checking! Disadvantages! Often overloaded! Patient Pick Problem Wellsoft MedHost Tracking Order Entry! A staple of ED computing! Helpful on many levels! Status of a patient's visit! Status of the dept as a whole! Serves as a launching point! Must have interfaces to drive the data! Advantages! Help avoid dosage and allergy errors! Potential productivity increase! Can be incorporated into order sets! Complete medication reconciliation! Disadvantages! Significant change in provider workflow! Interfaces most challenging Tracking Coordinated Data! Advantages! Proactively monitor the department! Keep ahead of the curve! Distributed viewing! Disadvantages! More expensive in the short term! Lack of integration Ibex Pulsecheck 6

7 What To Avoid? Documentation! Reasons we document! Medical Care! Medicolegal protection! Reimbursement! Though we don't like it Documentation Discharge! Advantages! Legibility! Quick retrieval! Research & Analysis! Improved content! Coding on-the-fly! Decreased RVU loss! Decreased billing expenses! Never look for the chart! Disadvantages! Speed / workflow! Interface issues!?bedside charting! Patients don't remember verbal instructions! Features! Add/Edit instructions! Multiple languages! Work notes! Prescription writing! Interaction/Allergy checking The ED Dashboard The ED Dashboard Clinical Exchange Department View PCP ID & notes Patient information (demographics & CC Labs just the essentials Patient View Rads wet reads/results Care team Clinical Charts Patient Discharge Alerts (e.g., MRSA) EKG current/ history MD & RN Comments Vitals manual/auto Admission information (time & status) Links visits & EMR 42 7

8 Decision Support Location Of Computer Terminals?! Aspirin in chest pain?! Antibiotics for infection?! Consideration of life threats?! Clinical pathways followed?! Administrative tasks complete? Safety Storage! Security! Department access! Psychiatric patients! Lock-down! Monitoring! General supply storage space! Orthopedic supply! Wheelchairs, extra stretchers! Trauma & resuscitation room storage! Decentralize commonly used supplies Family Emergency medical services! Waiting area! Phone, TV, Internet access! Storage of educational handouts! Pediatric! Bedside seating! Private family consultation room! Vending area & drinking fountain! Entry location & integration with decontamination! Work area! Storage location & access pem.stanford.edu 8

9 What To Avoid Mass casualty & decontamination! Positive, negative pressure rooms! Decontamination room! Multi-function design! Decontamination supply storage Flexibility! Change is inevitable! Prepare for daily, weekly, monthly operational modifications! Design for expansion! If you build it, they will come 9

10 What To Avoid Summary! Planning and preparation is everything in ED design! Appropriate resource planning essential! If you build it, they will come! Build for the future, not now! Incorporate ED information technology into design phase! IT infrastructure for current and future IT needs! Avoid big misses Resources! Books! ACEP: Emergency Department Design, A Practical Guide to Planning for the Future! AIA: 2006 Guidelines for Design & Const. of Health Care Facilities! Journal articles! American College of Emergency Physicians. Emergency department planning and resource guidelines. Ann Emerg Med May;51(5): ! American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians, and Pediatric Committee. Care of children in the emergency department: guidelines for preparedness. Pediatrics Apr;107(4):777-81! Zilm F. A new era of emergency care: planning and design consideration. J Ambul Care Manage Jul-Sep;30(3): ! Web!

11 Acknowledgements! Larry Nathanson, MD, Director of ED Informatics, BIDMC 11