All good stuff. I speak below from experience, so I hope it helps.
Architects ALWAYS skimp on storage space and loos. You need a lot of storage
space for a proper emergency department. Make sure that every patient on a
trolley can be seen from the nurses' station and do not hesitate to use
technology and CCTV where necessary with appropriate safeguards on security.
Insist on plenty of writing and leaning space - computer workstations are
not big enough - and storage for the ever increasing piles of proformas that
admitting teams are wedded to. The overcomplicated call bell systems are
largely rubbish despite being beloved by hospital planners and are not fail
safe whereas CCTV will still show the patient clambering out of bed. Don't
forget quiet rooms; have TWO if possible. The department must be
air-handled. You and I think of air conditioning, but to the architect it is
called air handling. Walls for majors and Resus must be coated in the
multilayer theatre spec paint for durability and easy cleaning.
The resuscitation room is most important to get right; I used pendants from
Kreuzer and did NOT waste a lot of money on Xray gantries. They are only
used to take 2 pictures on any patient and you get better quicker pictures
from the new digital portables. I can send you lots of pictures; the one I
designed is still working fine 10 years later. Everyone will shout at you
but you MUST insist on a dedicated CT scanner instead right by Resus. The
minimum size for a bay in Resus is 3m by 5m and ideally 5m by 5m - the
building notes are very out of date and you should not be cowed by them.
Double the number of power points and data outlets specified.
Think about access by staff, patients and others. Too many emergency
departments are simply a bulge on a major access corridor to the hospital
with all the lack of dignity that implies. Make sure the rooms don't have
daft errors like trolleys or sinks behind doors (guess how I know this?) and
if trolleys are against walls access should be from the patient's right.
Make no room so small that if someone collapses in it you'll have a devil of
a job getting to them. Have a separate paeds area completely that is not the
other side of the adult waiting room. Are you expecting a General
Practitioner UCC type area?
Think of staff flows and patient flows. Do staff have long meandering
journeys to somewhere like the sluice that is used a lot? Do patients go
round in circles going to imaging and back? Think about staff safety. Don't
create a little psychiatric assessment room that someone can be trapped in.
How will you create a safe but airy reception?
Try and envisage how people want to work and design round that rather than
hoping they will work round your design. They won't.
Best Wishes,
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC) A &
E - SwarkHosp-TR
Sent: 01 September 2009 14:30
To: [log in to unmask]
Subject: Re: Designing an emergency department
Other point worth noting (taking experience from design and build both
within and outside the NHS): don't trust the architect and project manager.
They're not the ones who are going to be stuck with the place. An architect
will always come up with the same design he's come up with a few times
before (usually a corridor with rooms off). You need to look at the design
and see if you can do better. There's a free bit of design software you can
download from google that's good for drawing up plans (once you get the
specifications from the HBNs and know what footprint you've got).
A few points on design I've found from some places:
Noise is a problem. Isolate noise. This usually means glass walls. Otherwise
you get a time when a patient crying out; some relatives holding a
conversation; a trolley getting wheeled along and staff discussing cases
gets loud. Everyone talks louder to be heard over the noise and it just
keeps getting louder.
Related to this, patients and relatives able to see staff chatting or
drinking coffee creates complaints. Patients and relatives being able to
overhear referrals is a breach of confidentiality. On the other hand, staff
unwinding for a brief break without having to go to the coffee room is
useful in a busy department. The "goldfish bowl" with one way glass is a
good idea.
Natural daylight is important. Skylights, big windows and glass walls
wherever possible. South facing glass walls can be an issue, but if you've
got a North facing wall, you want to look at as much glass as possible.
"Corridor effect" doesn't feel good. A big rectangular or oval space is far
better. Architects don't like it because it needs thinking about, but it
often actually wastes less space.
Curves are good. A bit more expensive to build in, but feel a lot better.
Try to future proof your office space. Individual offices are more efficient
than big shared offices and hot desking. Bear in mind you'll be expanding
consultant numbers.
Overnight rooms can make a huge difference to your staff. Even in
departments where they think they don't get a break all night, if you look
at what actually comes in between 1 am and 7 am there is usually scope for
someone to get their head down for an hour or two if you staff well enough
to clear the department by 1 am. A brief nap is healthy and improves
decision making ability. Also remember that in a few years' time you'll be
pretty low on trainees at night, so the night shifts will often be done by
permanent staff in their 40s, 50s or 60s.
Coffee room needs to be a pleasant place. Think of proportions between
length, width and height. Consider the "golden ratio" (roughly 1.6: 1) and
its multiples as found extensively in Palladian and Regency architecture. It
feels nice.
Matt Dunn
Warwick
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