-By Stephanie K. Statz, IIDA, CID, LEED AP

"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's article focuses on security and emergency departments

Security requirements in medical facilities are often at odds with providing a calm, non-threatening environment, where patients come for treatment and healing.  The emergency department (ED) is a great example of this. Merriam-Webster dictionary defines “security” as “the quality or state of being secure: as a: freedom from danger: Safety b: freedom from fear or anxiety.” The very definition of the word security represents the dilemma faced in the ED.
 
Patients and visitors may experience any or all of the following stressors while in the ED:
•    Lack of control
•    Lack of privacy
•    Fear of an aggressor
•    Fear for a loved one
•    Fear of the unknown

This may in turn cause staff members to become stressed or put them in danger when a patient or visitor lacks emotional control over their circumstance of being in the emergency department.  So how can interior design contribute to the security and protection of the patients, staff, and facility while helping to minimize the anxiety of distressed patients, visitors, and staff under pressure? 

The entry to the ED is the first security point and should be clearly marked, accessible, and transparent. In our current environment of heightened security needs, controlled entry and protection of the staff and patients is key. However, various cultural settings might be handled differently. For example, while a security camera and electronic lock may be adequate in a rural setting, a police officer may staff a metal detector at the ED entrance in a community where gang violence may be an issue. Although this solution seems much harsher than the rural option, it actually may bring comfort to patients and staff to know security is present and they are protected should someone intend to bring harm.

Triage should allow for patient confidentiality during the admission and assessment period to keep information secure and give patients a sense of control. Private booths or rooms are a good solution, but sound masking at a minimum will help accommodate confidential discussions in facilities where private rooms are not an option. Locate caregivers in a position so they may escape a room or area if a dangerous or threatening situation arises. The ability to lock down an area may also be necessary to protect people during a potential attack.

A visit to the emergency room almost always is accompanied by a waiting period for the patient and/or accompanying loved ones, and during this time, stress may elevate due to the lack of control, privacy, and fear of the unknown. To help alleviate anxiety, St. Mary's Hospital in Grand Junction, Colo., took the following approach: Emergency patients "will be given an initial assessment after they enter. Then, they will be immediately moved to either a non-critical sub-waiting area or a treatment room rather than being sent to the general waiting area," according to Kase Macosko, project architect, LEED AP, of Perkins+Will.  "Patients will feel their needs are being quickly addressed as a result."

Organizing seating to accommodate separate groups or families also gives a sense of privacy.  Ensure that all seating has a view to the desk or call point and that the staff has a view of everyone in the room. Feeling that it is possible to make eye contact with a staff member helps the patient feel more in control. A view to the waiting area allows staff members to constantly evaluate the patients’ condition and to spot immediately if anyone’s stress level is elevating to a point that a perilous situation might occur.

Finish the space with durable and cleanable furniture, fixtures, and finishes. Use harmonious colors to sooth and calm. Provide positive distractions such as television, magazines, art, or aquariums.  South Georgia Medical Center (SGMC) in Valdosta, Ga., included a separate enclosed play and waiting area for children in its new ED design. (Click here for SGMC floor plan.)  "It keeps children and their parents out of the Saturday night emergency department where injuries due to violent acts are common," states George Hardy, assistant administrator of ancillary services at SGMC. "It also served as a safe assembly or collection point for the children following two recent school bus accidents."

In the end, security in the emergency department isn’t just about locks and metal detectors. It is an integrated approach to the design to reduce stress and gain control by patients and caregivers alike.

Stephanie K. Statz, IIDA, CID, LEED AP is a senior interior project designer with Perkins+Will Minneapolis' healthcare discipline.  She has 13 years of design experience in a wide range of interior architectural projects. She can be reached at Stephanie.Statz@PerkinsWill.com.

Sources:
Arneill, Allison B., and Ann Sloan Devlin. "Perceived Quality of Care: The Influence of the Waiting Room Environment." Journal of Environmental Psychology 2002.
Crowe, Timothy D., Crime Prevention through Environmental Design , 2nd ed.,  Boston: National Crime Prevention Institute, 2000.
Laskowski-Jones, Linda, et al. "Assessing and Planning for Triage Redesign". Journal of Emergency Nursing  31.3 (2005): 315-318.
 
Past installments of "Designing for Health" include (click on title to access the full article):
• We Eat What We Build
• Evidence-Based Healthcare Design Forum
• Designing the Ideal Space
• The Importance of Family in Patient Rehabilitation
• Maximizing the Impact of Art in Architecture
• The Benefits of Healthcare Learning Environments
• Making Hospitals More Hospitable for Children and Their Families