Most people probably wouldn’t compare a visit to a hospital emergency room to the luxury first-class cabin of an airplane. But that’s how HKS designer Jim Lennon saw things when he started thinking about how to help health systems solve their most pressing problem: how to maintain their operations when they have far more patients than space.
“I took a look at the airline industry,” Jim said. “They studied what amenities passengers wanted around them that would encourage them to pay substantially more for a first-class seat than a person in coach. Especially, when you consider that first class lands at exactly the same time as coach.”
So when Chicago’s busy Northwestern Memorial Hospital (NMH) asked HKS to renovate its emergency department, Jim, the project’s lead designer and creator of NMH’s ED pods, called on that luxury aviation research. As a result, the ED pods at NMH include things like patient-controlled lighting. A touch panel controls lighting levels with settings for full “exam” lighting, dim and “healing.” The healing setting is a purplish hue designed to reduce stress based on the Baker Miller Pink research that demonstrates how the use of color in light can affect mood.
The pods also contain a motorized ergonomic patient recliner chair that easily converts to a fully reclining stretcher in case the doctor needs to do a more extensive examination or a waiting patient — much like an international airline passenger — simply wants to stretch-out flat to sleep.
In addition, a curved back wall that features several motorized touch panels that conceal medical equipment and supplies from the patient’s view. The wall also has compartments for patient belongings (think airplane overhead bins) and charging stations for the patient’s and family’s mobile phones or other digital devices.
“There are about 20 supplies that doctors use consistently in emergency exam rooms,” Jim said, noting tongue depressors, tape, scissors and gloves among such items. “We put them behind the wall. They’re in exactly the right place to be used but are not accessible to the patients. And at NMH, they put a keypad on the supply drawers allowing them to store sensitive materials like syringes that are good to have near the patient, to reduce nurse walking, but are normally not found in conventional exam rooms because of the additional security needed. ”
The curved wall focuses sound from the caregiver or physician down toward the patient and floor to help minimize sound propagation between the pods. An option that NMH choose not to incorporate, is an overhead speaker that creates a cone of sound about 4 feet in diameter and goes not 1 inch further, regardless of the volume of the sound. Jim calls it “amazing technology” that has been used by the CIA and is relatively inexpensive.
But perhaps the most tantalizing feature of the new spaces, is their size. Because hospitals ED’s are pressed for space, the HKS design team faced the challenge of delivering a project that would serve more patients in the same amount of space. What Jim realized from his research was that not all ED patients are created equally, and therefore, they don’t all need the same amount of treatment space.
Some patients are very sick and need to be on stretchers in a private room (“horizontal” patients) and some don’t need all of the services and space of a private room (“vertical” patients).
The standard emergency exam room today is 140 square feet, but “you don’t need that much room for every patient,” Jim said. “At $600 per square foot, 140 square feet ends up being a lot of money.” Instead, through research, he determined that 48 square feet would be sufficient for about 50 percent of emergency room patients. The other half, those with severe trauma or illness, would still need the standard private exam room.
At NMH, 16 new pods were created for vertical patients. The space those pods occupy would have only resulted in four regular sized emergency exam rooms.
“At NMH we literally increased the capacity of their emergency department by 25 percent, within the confines of their current emergency department,” Jim said. “It increased the number of patients they have the capacity to see on a daily basis.” In addition, potentially the number of patients one caregiver could serve might increase from four to six.
And much of the Pods surfaces are covered with Corian, a highly cleanable and durable material.
The Pods are also dramatically different from a visual standpoint. Emergency departments can be intimidating places. They are often noisy, crowded and harried. And their exam rooms may feature a wide variety of medical equipment protruding from walls that can appear scary to a patient. The goal for the ED Pods was to create a calming space that gives patients a level of control over their environment where possible.
Still, while more hospitals are opting to create small spaces for minor acuity patients, few architects have spent as much time as Jim and HKS have to research the needs of these patients. For example, while the space in the pods is significantly less than a conventional emergency exam room, it has space for family members, and their chairs fold up and hang on the wall, which opens up the floor area for other functions.
Another option that is available, but wasn’t utilized at NMH, is a ‘utility arm’ that could house a pull-down shelf for patients to put drinks, personal effects and mobile devices along with USB and 110v outlets to charge them. NMH utilized a smaller fixed shelf for a beverage or to hold a mobile phone for charging. Additionally, a swing-out iPad could be located in the utility arm to allow patients to communicate with caregivers and translators, watch movies, read books, order food and determine where they are in their stay.
The pods increase access to emergency services for patients, while reducing waiting time and provides more income per square foot for the hospital, which is important to the hospitals bottom line and allows them to invest in more innovation for patient safety and convenience.