3. Introduction to FreemanWhite
Development of a Comprehensive Healthcare Consulting & Design Firm
A Focus on our Clients
Business Success
Strategy
Strategists
Strategic Planning
Business Planning
Market Analysis
Operations
Process
Engineers
Operational Analysis
Process Improvement
Staffing Analysis
Technology Facilities
Low Voltage Systems
Communications / IT
Medical Equipment
Technology
Planners
Planning
Design
Interior Architecture
Engineering
Architects
Engineers
ED
Consulting
Team
4. The Team
• FreemanWhite Team
Jon Huddy, AIA, Managing Principal,
Lead Programming, Planning
Chris Morales, AIA, Project Lead Architect
Jim Jepson, AIA, Senior ED Designer
Kristyna Culp, MBA, Data and Process Analyst
Freda Lyon, RN, MSN, NE-BC, ED Clinical Specialist
• Michaud Cooley Erickson
Greg Trende, PE, Engineering Systems Analyst
Architectural, Engineering and Process Analysis Team
5. ED DesignFlexible
Efficient
Physical
Design
Solution
Four Step Process to Success
The task of designing your physical environment is the
opportunity to create the way that you will deliver care in
the future.
Analysis
Strategies
Patients
Operations (lean)
Technology
Facilities
Future
Vision
Define lean
Operations,
Technology,
And Customer
Service Patterns
Project Scope
Definition
Early Design
Concepts
1 2 3 4
March 14
March 24-25
April
10-11
April
22-23
May 20
7. Project Success
• “Care design that fits into the existing space”,
• “No redesign within 5 years (Stands the Test-of-Time)”,
• “Flexible design that adapts to changes in the marketplace”,
• “Establishes a sense of community pride”,
• “Efficient and beautiful”,
• “A safe and comfortable healing environment”,
• “A plan that accommodates family needs (family spaces)”,
• “Good Ancillary support (buy-in from other departments)”,
• “Great environmental systems (no need to think about heating/cooling
problems)
• “Mix of specialty spaces combined with flexible general spaces”,
• “Need to focus on raising the level of care for stroke patients”
• “Need consistent process that can manage surge capacity”
March 14, 2014
8. Current Likes
• Close to Imaging
• Redundancy of treatment spaces
• Current team profile (3 nurses + 1 provider)
March 14, 2014
9. Current Dislikes
• Good side (North ED) VS Poor side (South ED) “ Hawaii VS Bosnia”,
• Storage Poor (need more appropriate storage for supplies and equipment),
• Some rooms do not work ergonomically,
• Need to better accommodate older, sicker and larger patients,
• Many rooms are not set up the same (need to have a universal layout),
• Some bedside charting areas place the backs of staff to the patients,
• Poor I.T. Access (need flexibility for current and future Technology),
• Public access elevators in the middle of ED flow
• Not enough patient toilets,
• Noisy environment (little privacy), esp. in East work area
• Charting areas not near patient care
• Poor proximity to supplies, meds
• No good, consistent space to wash hands
• Mental Health situation unsafe
• No grieving area
March 14, 2014
10. Comments/Issues/Concerns
• Little or no Peds volume (Peds hospital across the street),
• Psych – 15% of volume is adolescent with 6-7 hour stays average,
• OBS (CDART) may move somewhere else,
• Need improved supervision at walk-in entrance (assure public and staff
safety)
• 55K annual volume for future benchmarking,
• 22-25% of volume are ambulance patients,
• North ED opens at 9:00 am-3a, East ED opens at 11:00 am-9p or 11p
• Behavioral Health is not in the Data set (look for A&R Consult)
• Interaction of Heart Center Hospital pts
• HVAC separate from Heart Hospital
• Need Hot water and working sinks
March 14, 2014
11. Updated Data
• Behavioral Health
Mental Health Designation =~7%
ICD9 diagnosis codes=~9%
15% adolescents
Includes Drug and Alcohol
• Imaging
• Data by Day
25. Behavioral Health
• Insufficient space for volume
• No space
• No designated room(s)
• Have good relationship with ED
• Would like Obs type option for MH
• Not safe
• A&R in close proximity to department
• Have up to 3 staff on need space
• Do telehealth assessments, need space.
• Panic button per person
• Check distribution of LOS
26. BioMed
• Will be replacing telemetry this year
• Need to install AeroScout to find devices
• New system allows staff to check on repair schedule
• Incorporate space for minor repairs currently 20m walk to work space
• Need celling lifts in every room, most don’t have enough room for portable lift
27. Integrative Med
• No space
• Need alert in EDIS, use phone now
• Sharps containers on both sides of room
• Space in triage area for simple tx
• Huge focus on this approach from donors, need to expand
28. Cardiology
• Quick TAT
• Communication is good
• Amb entrance to tx is issue, past elevators
• EDIS is difficult when pt moves quickly from ED to CathLab etc doesn’t
accommodate quick moves
Cardiac Emergenc
30. EMS
• Need smaller amb or bigger space (new trucks are much larger than older versions
need more space
• Flow is rough
• Garage holds up to 10 trucks
• DC and Amb drop off in garage
• Street to Entrance to treatment space
• Decrease backing in, prefer drive through
• Works stemi process
• Transports always ready once EMS arrives
• Communication is good
31. Endo
• Designated RN from ED for sedation
• Adequate suction
• Issue with communication of order
• Most work is after hours
• Would like a secure cart storage area for after hours
32. EVS
• Need space for water in and out
• Finishes will be important
• HK closets
33. Disaster Planning
• Communication for training is great
• Decon shower is portable need built in
• Decon equipment storage space need
34. Linen
• Need storage space for 5-6 carts
• 1500-2000lbs linen/day (most 24h =500lbs)
35. Equipment services
• Room size
• Bariatric eq needed
• No consultation rooms
• No quiet rooms
• Transport process works well
• Computers in each room
• Need dirty room for equipment cleaning
36. Hospitalist
• Need overflow area for patients when admit process blocked with privacy
for interviewing
• Need more stations for charting outside of doc area
• Need ability to get accurate pt weight
37. Orthopedic Surgeon
• Imaging TAT, moving patient over and back
• New space further from imaging
• Variable assistance staff and equipment
38. Infection Control
• Need more isolation rooms and ability to surge for isolation
• Sinks/handwashing
• TLT in ED rooms (some)
• Finishes work with Allina standards
39. IS
• Need data closet space!!! At max cap currently
• Downtime for EPIC will be better in the future, decrease time
• Looking at pt ed system
• Moving to Tablets for providers
• Moving to wireless phones
• Portable xray
• Bedside bar code
• EDP order preference list
40. Lab
• Located in ED
• Labels print in ED lab
• Close to everything
• Paging system works well
• Room sq. footage ok but layout poor and poor ventilation
• Closet size may not work for future volume
• Need dirty sink for sample void
• Need good wireless connect
• Need to be close to tube
• Phlebotomist in ED since 2006
• Moving to bedside bar code system and label printer on cart
41. Materials Management
• Implemented centralized supply area
• Need more space for bigger bins for 3 days worth of supplies, currently have
1 day
• Disaster supplies are across campus
42. Mother Baby
• Getting pt to appropriate space
• Trying to share protocols
• Far away from ED across street
• Make sure >20wk pts are treated quickly
• Need space for equip and supplies
• Communication chain for postpartum pts
43. Rad
• Proximity good
• Communication good
• Poor prep/recovery area
• Moving to bar code system for portable rad
• Need to standardize supplies and equipment
• Need to think in the future about using imaging prep area for surge
44. Registration
• Communication with triage is good
• But privacy is not
• Some issues with EMR numbers as RNs arrive pts instead of reg
• Bedside reg difficult in small rooms
• Expanding financial counseling role to evenings and weekends will still go to
bedside but need office
• Would like one reg booth to reg (family) when queue for bed forms
45. Respiratory
• Wireless phone system works
• Always keep one Vent in the ED
• Bipap unit not consistently stored in ED
• No piped med air into ED
46. Security
• Communication with leadership
• Secured perimeter but could be improved with better glass
• Need perimeter lock down
• Pt valuables are locked
• Gun locker in place
• BH suite needs to be together
• Violence prevention in design
• Need camera coverage esp BH
• Securable psych rooms and/or flexible tx rooms
• Radio coverage is difficult
• Remote access for triage to buzz someone in
• Panic devices need throughout
• Lobby needs to be more visible
• TLTs need to be close to phones??
• Security needs to be in lobby visible
• Need TVs in rooms
47. Trauma
• Need shorter distance to room from amb
• Pt out within 30m is goal
• Otherwise works
48. Telehealth
• Need space for mobile Telehealth carts will be wireless but also need data
drops.
• Need area for medical staff to conduct tele health visits with other
organizations/hospitals
• Area needs to have audio and visual privacy. there will be 2 -3 monitors for
the MD to use for the visit. (1) to view the patient, (1) to document in the EHR
and (1) for image viewing
