President t. howard + associates, USA
The Baylor University Healthcare System is a Christian ministry of healing that serves patients by providing exemplary healthcare, education, research, and community service. It was founded on the principle of improving community health by addressing identified needs. The Baylor University Medical Center Emergency Department (BUMC ED) located in downtown Dallas, Texas has been operating near capacity for almost 10 years. The high number of patients combined with the dearth of resources made providing top-notch healthcare more difficult. To correct this issue, Baylor brought in North Carolina-based architect FreemanWhite and local architect t. howard + associates to perform a renovation and addition to the ED.
Healthcare coverage for Texans ranks among the worst in the US, largely because so many Texans go uninsured each year. Twenty five percent of all Texans have no health insurance, which precludes them from having regular check-ups that could catch illnesses before they magnify into emergencies. Other insured workers have no medical leave, which leaves them with little opportunity to visit a physician regularly. These translate into high levels of ED traffic. In fact, a third of individuals in the US visit an emergency department each year. The Dallas Metroplex's population has enjoyed nearly 30 per cent growth rate over the past decade and is still growing steadily. This adds to the number of people visiting the ED each year.
When emergency strikes, few centres in Dallas are able to provide levels of patient care equivalent to the The Baylor University Medical Center Emergency Department (BUMC ED). It is one of only two Level One Trauma Centers in the North Texas Trauma Network. This designation signifies that the centre provides the highest of level of surgical care to trauma patients and maintains capable personnel in-house 24 hours a day, seven days a week for prompt diagnostics and treatment of the most critically injured patients. The increased demand on the BUMC ED over the years has caused the ED to outgrow its space, thus requiring larger work areas to alleviate overcrowding in order to maintain the high standards of efficiency and patient care. Prior to the ED expansion, patients sometimes had to wait for more than three hours to see a physician. One of the end goals was to significantly reduce the waiting time.
With the aim of improving patient service, the BUMC board of trustees began planning the new ED in early 2005. FreemanWhite and t. howard + associates (THA), architectural firms with a strong healthcare focus, were brought on board to help fulfil the trustee's vision for the project. The ED went under the knife for a renovation and expansion of the existing department to increase patient volume and improve quality of care and staff retention for a comprehensive cost of US$ 53 million. The design team strategically planned to expand the area of the department from 33,000 sq.ft. to 78,000 sq. ft., more than doubling its patient capacity. The total number of beds increased from 34 to 87, majority of which are now private. A large trauma area was built to accommodate up to eight injured persons.
One of the challenges the design team faced was making a noisy, bustling emergency room tranquil without disrupting workflow.
A large waiting area was broken into several parts allowing families to congregate in relative privacy, while sub-waiting areas spread throughout the ED provide the family comfort and proximity. The private patient rooms, all equipped with enough seating for family members, a television, and a phone, helped speed the treatment process while increasing the care quality and sanitation. The orientation and equipment provisions are typical in each treatment area. Dimmable lighting allows maximum comfort and in place of privacy curtains, electrostatic glass becomes opaque at the flip of a switch. Furthermore, imagine patients needing to visit the ED and being able to call their doctor ahead of time and ask him / her to meet at the hospital. Patients who have doctors with practicing privileges at Baylor are permitted to the use of a new physicians' waiting area and are able to meet with their caregivers in a more efficient manner. This reduces the number of patients in the general waiting area. Treatment rooms are orientated around centralised care team stations to assist with operational efficiency during non-peak hours. The new silence in the ED will help alleviate stress in both staff and patients alike.
Baylor wanted durable finish that added an inviting and professional look to their facility, without requiring a lot of maintenance. The ED is designed to welcome the patient through careful selection of colours. The wood elements and stainless steel used throughout the facility have a modern and approachable appearance. Visual monitors featuring calm virtual aquariums are spread throughout the larger waiting area. In times of high activity, the monitors transition to a dedicated Baylor channel with nature scenes and soothing music. Terrazzo flooring is one of the lowest maintenance solutions available and can survive the heavy scrubbing required in the ED. With lower maintenance finishes, patients and staff aren't subjected to the constant noise of cleaning, waxing and buffing.
To make the experience more personal, the Baylor Foundation focussed on bringing in artwork from local artisans for the ED. Individual art pieces can be found in each of the treatment rooms and numerous three-dimensional wall art pieces can be found throughout the facility, adding a feeling of brightness to the ED. Artists were commissioned to paint one-of-a-kind watercolours featuring local landmarks. In addition to being visually stimulating add-ons to the ED, they also assist in wayfinding.
Even though the ED is large, the design is simple. The care team pods are located in the centre of the facility with the treatment rooms lining the perimeter. These facilitate communication and increase efficiency among the staff. There are strong visual connections throughout the ED, so staff can clearly see inside the patient rooms and also from one care team station to another. In order to help patients and staff find their way easily, different colours are used for each care team pod. The design team helped cut down on visual chaos by creating niches in the corridors for drug distribution machines and crash carts. With everything having its own dedicated space the hallways get much calmer.
The ED also benefits from cutting-edge technology upgrades: four X-ray units, two CT scanners, an Ultrasound, a Lodox and upgraded lab services are now available within the department. Computers are located in every patient room, which increases the amount of time staff can spend with patients. With a large decontamination room, containment room and showers, the ED is prepared to face disasters and biological threats. A total body digital imaging system, Lodox Statscan is located in the trauma area allowing the trauma staff immediate access to the imaging equipment.
In the unfortunate event of a patient passing away, a body viewing room is incorporated into the design. This small divided room allows patients' families to view their loved ones when they are prepared and allows the staff space to speak with the family in seclusion without interruptions. The design team has incorporated vinyl flooring resembling wood, soft wall paint covers and furniture. The result is far preferable to a chaotic trauma room or a sterile morgue.
It was important that the ED remain fully functional during the renovation and addition. Construction was carefully phased so as not to disrupt the ED's ability to care for patients and the ED was able to treat 110,000 patients during the seventeen-month construction period. Other departments that had previously been located in the ED's new space were seamlessly relocated within the hospital's footprint without adversely affecting the hospital's patient load capability. The design began in December 2005 and the final construction was completed in January 2008.
Now, the waiting room in the ED is no longer overflowing. Patients aren't subjected to wait for three hours. Baylor's trustees and staff can comfortably accommodate additional increase of patients. This state-of-the-art department rivals any ED in the country. The completion of the new ED will help the Baylor system to better serve their patients as well as the community.
Todd C Howard is the President and Founder of t. howard + associates architects (THA). He received his Bachelors degree in architecture from Texas A&M University and specializes in healthcare, educational, and not-for-profit design. Todd is an active member of numerous professional organisations, such as the American Institute of Architects, serving as the Dallas branch's President Elect for 2008, Texas Society of Architects and the Dallas Architectural Foundation. Todd is also a passionate community volunteer. This year marks THA's 10th anniversary.