Critical Care 1950 to 2022: Evolution of Medicine, Nursing, Technology, and Design.

Critical care units-designed for concentrated and specialized care-came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. After WWII, medical practice and education promoted further specialization. Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room's level of observation and specialized nursing to serve the critically ill, whether medical or surgical.

Design of the Academic Emergency Department.

This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages.

The Creative Healthcare Architect.

The objectives of the research described in this article focus on an understanding of factors that influence creativity in healthcare design. Two areas of emphasis include the personality strengths of successful healthcare architects and elements of the current project delivery process. As part of the research, 48 healthcare architects participated in a battery of personality and creativity tests including Myers/Briggs, The Big Five, the Remote Associates Test (RAT), and an architectural creativity test. Results of the test point to strong "openness" for new ideas, particularly with the designers sampled. As a group, respondents scored low in "narcistic" bias (indicating emotional stability) and did not score high in verbal creativity. Compared to earlier studies of creative architects, the sample group included significantly fewer "perceiver" (Myers/Briggs), associated with a high level of curiosity. A second interesting finding was a significant difference between younger and older architects in the architectural creativity test. One possible hypothesis is the experience of the older architects. A second, and potentially more alarming, hypothesis is that technological disruptions are interfering with the ability to stimulate divergent thinking, particularly in the younger generation raised with smart phones and other network tools. Creativity in healthcare architecture demonstrates the case for domain-specific experience and skills along with creative input from other knowledge domains. The ability to establish group creativity may be inhibited by pressures to condense project time lines and not fully implement lean and other process strategies for exploring alternative solutions. Effective participation in group creativity tasks is particularly important for the complex world of healthcare design.

Integrating disaster preparedness and surge capacity in emergency facility planning.

The ability to adapt and utilize emergency facilities is a critical element in responding to surges resulting from man-made and natural events. The current stresses on emergency services throughout the country find few adequately prepared to effectively absorb a sudden increase in patients along with some of the potential special requirements, such as quarantining of epidemic patients and mass decontamination. This article reviews major findings of the federally funded ER One project, a research initiative that has described a number of facility strategies, which should be considered in planning new emergency facilities. An early case study in the application of these principles at the recently completed Tampa General Hospital emergency service is provided, illustrating how, when integrated into the early planning and design, many of the ER One recommendations can be implemented at modest capital cost increases.

A new era of emergency care: planning and design consideration.

Emergency care is one of the most complex, rapidly growing areas of ambulatory care. Providers need to consider new issues related to management of low-acuity patients, capacity for surge events, and the need to integrate patient focused care into the emergency department environment. This article explores these issues and discusses basic organizational topologies for facilities.

Estimating emergency service treatment bed needs.

Estimating the required number of emergency service treatment beds must be sensitive to utilization patterns and strategic operational assumptions. This article describes key issues and illustrates techniques for the analysis of arrival and service times. Seasonal arrival patterns, time of day of arrivals, and common statistical distributions for length of stay are discussed. Alternative modeling approaches to estimate future bed needs are described, including visits/year per treatment space, simple queuing modeling, and detailed computer simulation. Sample estimates of treatment rooms needs are provided for typical arrival rates and lengths of stay. A generalized regression model based on the simulation trials is suggested for cases that fall outside of the illustrated simulation case studies.

Virtual ambulatory care. Computer simulation applications.

Computer simulation modeling has evolved during the past twenty years into an effective tool for analyzing and planning ambulatory care facilities. This article explains the use of this tool in three case-study, ambulatory care settings--a GI lab, holding beds for a cardiac catheterization laboratory, and in emergency services. These examples also illustrate the use of three software packages currently available: MedModel, Simul8, and WITNESS.

New directions in emergency service operations and planning.

Emergency services continue to evolve new operational and facility concepts in response to increasing demand for care and pressures for efficient, and safe, patient management. This article describes new models for "intake" of patients and for responding to peak demand that are radically changing the traditional emergency service. Application of Six Sigma and "Lean" analysis techniques are demonstrating dramatic improvements in throughput times and in the utilization of treatment spaces. This article provides an overview of the application of Lean concepts to emergency services. Case studies of Mary Washington Hospital and Banner Health Corporation illustrate the result of application of these tools. Implication for the required patient care areas and design concepts are also discussed.