Security Implications of Physical Design Attributes in the Emergency Department, Health Environments Research & Design Journal 2016, Vol. 9(4) 50-63
Objective: The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of emergency department (ED) operations.
Background: Security, a subset of safety, is equally important in the efficient delivery of patient care. The ED is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel.
Method: An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states.
Results: Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations. Conclusion: Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.
Debajyoti Pati, PhD, FIIA, IDEC, LEED AP, Professor and Rockwell Endowment Chair, Department of Design, Texas Tech University
Dr. Debajyoti Pati is currently serving as professor and Rockwell Endowment Chair at the department of design, Texas Tech University. He has researched, published, and presented, internationally, on the interactions and intersections among physical design, people, and processes, in healthcare settings. He was twice voted among the 25 most influential people in healthcare design, and has received more than ten national and international awards for research excellence. He currently serves as the director, USA Chapter, of the International Academy for Design and Health, on the board of directors of the AIA-NIBS BRIK program, and on the editorial board of HERD. He is a Fellow of the Indian Institute of Architects.
Sipra Pati, MA, Healthcare Design Research Consultant
Sipra Pati is a Human Geographer who has been conducting research in Healthcare Design for the last six years. She has worked with HKS Architects, CADRE, and CHD. She has several publications in peer-reviewed and other journals and has been part of research projects that have been awarded by EDRA CORE and IIDA. Her past research interests examined the spatial attributes of inhabited spaces, the conceptualization of space as a physical entity on domestic violence, and inhabitants’ perceptions of space and employee behavior in industrial workplaces. Her work in the context of healthcare design draws on her understanding of these critical relationships.
Thomas E. Harvey, Jr., FAIA, MPH, FACHA, LEED AP
Tom has invested his career of 35+ years as an architect, operations consultant, educator and researcher in design for healthcare facilities. He is a Fellow of the American Institute of Architect a Fellow of the American College of Healthcare Architects and is EDAC certified. His leadership and ideas have influenced an extensive array of environments for healthcare-related missions within settings ranging from rural to urban academic teaching enterprises. He holds the distinct honor, among these accomplishments, of leading the naval design team design for our nation’s two hospital ships, the USS Mercy and Comfort.
His passion focuses on optimal performance of the buildings that emerge from his practice. He organized and is a member of the HKS’ Knox Advisors (business consulting), and is the President and Managing Principal of HKS’ Center for Advanced Design Research & Evaluation (CADRE), a non-profit organization dedicated to rigorously distilling and disseminating quality research evidence relevant to the improvement of design. This focus has led to an innovative design approach intent upon informing design by operational discoveries and evidence from rigorous research in practice.
Alan J. Card, PhD, MPH
As a Research Associate with The Center for Health Design, Dr. Card has been invaluable in several special projects including the development of the CHD online Safety Risk Assessment. He holds a PhD from the University of Cambridge, and an MPH from the University of South Florida, as well as professional certifications in public health (CPH), healthcare quality (CPHQ), and healthcare risk management (CPHRM). Dr. Card’s interests include the conceptual frameworks, tools, and techniques by which health service organizations improve patient safety, healthcare quality, patient/user experience, and disaster preparedness. He is the editor of the Journal of Healthcare Risk Management.