Yale-New Haven Hospital, New Adult Emergency Environment of Care, New Haven, CT

SALVATORE ASSOCIATES + CAMA, INC.

EBD Goal

The interdisciplinary design team pursued the creation of a total environment of care with the following objectives:

• Reduce patient and visitor stress
• Reduce wait times and improve flow
• Improve staff sightlines both for security as well as clinical care
• Capture natural light and views of nature at an urban edge 

Challenge

The team was challenged to plan and design a facility that would accommodate the delivery of new models of care. The major challenge involved adding 20,000 square feet of new construction to 32,000 square feet of existing operational space.

Solution

Upon entering the new adult emergency environment of care (EEOC) patients and families are greeted by a triage nurse and a registration staff team.  Name and chief complaint are requested as they are visually triaged by the nurse and immediately escorted to the appropriate care area.  Further triage and diagnostics are done once assigned to care staff and location.  Should the initial triage require a physical examination, triage rooms have been located behind the three initial triage/quick registration desks. Once assigned to the appropriate care location, unobstructed views support a highly technical and critical operation by improving communication between caregivers.  This proposed process is to assure the appropriate level of care and expedite delivery of care for each patient.
 
Chair-centric care delivery has been approved for patients triaged at Emergency Severity Index (ESI) Levels 4 and 5 and some preliminary findings are indicating that this approach reduces patient stress, medication levels, and required square footage while increasing patient satisfaction and throughput.  A research study has been planned to collect data that will further question or support these findings.
 
Safety is an issue in urban healthcare settings but corresponding design solutions should never compromise the healing environment. Security is strategically located adjacent to the triage desks to allow for direct visual and physical access to the entrance and family support areas without overwhelming the entry experience.  The glass curtain wall system and the adjacent glass vestibule allow visual assessment of any potential threat prior to entering the building, while also calming visitors with views of the outdoors and daylight.  
 
Visual access to nature and natural light were also maximized in both the clinical/staff and public areas. The image exemplifies the implementation of this design intervention in a chair-centric exam area. Art-enhanced wayfinding solutions were also incorporated into this project. Regionally specific artwork is strategically placed to create memorable moments and provides direction and diversion.