Emergency Department

There are several negative aspects that come to mind when discussing ED waiting rooms, but there are three very prevalent issues that are constantly being battled in ED design. Overcrowding, increased wait time, and patients leaving without being seen are all problems that don't necessarily have an exact solution yet. Although there are many ways to combat each of these problems, there are always negative aspects that coincide with them.

Alternative Techniques used in ED Waiting Rooms:
Ball Memorial Hospital in Muncie, IN
Although this example eliminated the wait for patients to be placed in a room, not having any waiting area can become a problem when the rooms become full. The issue arises of where to place patients in this case, however rare it may be. This case does eliminate the likelihood of patients leaving prior to seeing a doctor though since they are already placed in a room. They would be more inclined to stay if they were more comfortable and at ease with their privacy.
  • The first "no-wait" emergency department in the country
  • Eliminated the waiting room completely
  • Took the designated waiting area and converted it into 35 private rooms
  • Each private room has a television and phone
  • Allows patients to wait privately in a room rather than uncomfortably in a waiting area with several other patients
  • Patients register at a desk when entering and are then transferred directly to their private room
  • Overcrowding
  • Not as efficient when moving patients through the process
  • Patients are left sitting in individual rooms for longer periods of time that if they had an initial wait in the waiting room
  • When all of the rooms are full, additional patients are redirected to an adjacent "coffee shop" space
Emergency Severity Index (ESI) Triage System
This was developed to define the severity of patients illnesses when visiting the ED. The ESI triage system is based on 5 categories, 1 being the highest severity and 5 being the lowest. "Urgent" patients are those meeting criteria for category 3 or higher. The intent is that the patients with EC1, EC2, and EC3 will be treated more promptly due to the severity of their illness.

Case Study:
Completed in a 19-bed academic military community hospital ED
Emergency Department Waiting Rooms - Health Architecture
  • Patients with highest severity illnesses are seen first
  • Patients have a quick initial assessment rather than waiting for a long time before being assessed

  • Increased wait time for patients with lower severity illnesses
  • Patients with lower severity illnesses leave without being seen

Music and Aromatherapy
Anxiety and stress are very common among people found in ED waiting rooms. Overcrowding, and extended wait times undoubtedly contribute to this, but as the other techniques showed there is always a positive and negative side when dealing with these issues. When overcrowding and waiting is unavoidable, there are still other techniques that can be used to relieve anxiety and stress that patients may be experiencing.

Case Study:
Completed over 28 days measuring the affect music and aromatherapy have on patient stress levels

Emergency Department - Health Architecture
  • Results found that there was a significant decrease in anxiety levels on days when music was played in the ED waiting room
  • There was a moderate decrease in anxiety levels when aromatherapy was used alone
  • Music and aromatherapy used together had the same results as when music was used alone

1. Holm, L., Fitzmaurice, L. (2008). Emergency Department Waiting Room Stress: Can Music or Aromatherapy Improve Anxiety Scores? Pediatric Emergency Care. 24, 836-838.
2. Levsky, M., Young, S., Masullo, L., Miller, M., & Herold, T. (2008). The effects of an accelerated triage and treatment protocol on left without being seen rates and wait times of urgent patients at a military emergency department. Military Medicine, 173(10), 999-1003.
3. Romano, M. (2003). It's a whole new ER. Forget the crowded waiting room. In fact, forget the waiting room altogether. Modern Healthcare, 33(39), 30.

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