Emergency departments are notorious for their waiting rooms, but Northwell Health is redefining the perception.
“Fifteen or 20 years ago, you had these waiting rooms that had 60 seats in them, and they were full,” recalls Glen Tilkin, assistant vice president of capital projects for the eastern and central regions of Northwell Health. “In today’s emergency departments, you don’t see a lot of people in the waiting room, and that’s the idea.”
As Tilkin explains, Northwell is redesigning its emergency departments in line with the split-flow model of processing patients, and a shorter wait time is just one of the method’s benefits. As the name suggests, the system is designed to keep patients in a constant flow to shorten the wait time before seeing a physician or care provider.
Split-flow model emergency departments are set up in stages so that patients progress only as far into the department as necessary. The process begins when the patient enters the waiting room and is simultaneously registered and evaluated by a nurse.
“The nurse makes a determination about what level of clinical help they need, and then they make a decision on where that patient is going to go in the process,” Tilkin says.
A low-acuity patient—for example, someone who needs stitches—would be treated in a triage room and then sent home. A high-acuity patient could move from the triage room to a specialized section, such as an x-ray room or isolation suite.
The building design facilitates this process. The waiting room leads directly into the triage rooms, and the triage rooms lead into the core of the emergency department.
“We think about the way that the patient moves through the emergency department, and the spaces are designed to accommodate the patient’s needs,” Tilkin says.
Location: Bay Shore, New York
Of course, constructing in an active emergency department isn’t easy. The five-phase renovation of Southside Hospital’s emergency department will connect the existing building with an adjacent one through an infill structure, which will more than double the available space and redesign the layout in line with the split-flow model.
During construction, however, clinicians and contractors will have to share what space they have. In order to accommodate patient traffic, the construction team has to relocate entrances, ambulance drives, corridors, and patient spaces during the renovation.
The team uses the hospital’s statistics to determine the department’s least congested times and complete major rebuilds in those windows.
“If it has an impact on clinical space, we’ll try to work to their schedules,” Tilkin says. “We’ll convert a room over a weekend to a corridor to create an access point and then have to build that room somewhere else in the emergency department on a temporary basis.”
The outcome of these challenges will pay off for hospital staff. The redesign will create a 30,000-square-foot emergency department that includes new facilities such as a clinical decision unit (CDU)—otherwise known as a 23-hour unit. Rather than admitting patients into the hospital, clinicians can send them to the CDU to be evaluated for 23 hours, after which they are admitted or discharged. The unit will also keep patients flowing and expand resources for hospital staff.
“For almost my entire career at Northwell, Southside has been talking about an emergency department expansion,” Tilkin says. “It’s a big deal for them.”
Along with expanding the emergency department’s footprint, the design will create a new entrance for the hospital that will “change the face and the image of the institution.” For this project, Tilkin worked with architects at CannonDesign. Because Southside is located near the water, the design incorporates beach elements such as light colors and an open, airy structure. Most striking are the slats that run along the canopy and the waiting room ceiling that emulate a dune fence.
“That’s definitely a unique factor to the Southside project,” Tilkin says.
“We think about the way that the patient moves through the emergency department, and the spaces are designed to accommodate the patient’s needs.”
Location: Huntington, New York
Unlike the construction at Southside Hospital, the Huntington Hospital redesign had minimal impact on the hospital’s clinical operations.
For this project, Northwell constructed a new emergency department building in a different section of the hospital campus. Because the construction team did not have to navigate existing emergency department operations, they were able to complete construction in a single phase and opened the facility’s new doors in January 2017.
Constructing a new building gave CannonDesign greater leeway to create a modern building that would “pay homage to some of the older aspects of the hospital design,” Tilkin explains. The goal was to design a façade that would both stand out and integrate into the existing campus, including the 1916 hospital building in view of the new structure.
Tilkin and his team also used a terracotta panel system that included colors, textures, and architectural components to reflect features of the existing campus. “While it looks modern, it definitely blends,” Tilkin says.
Long Island Jewish Valley Stream
Location: Valley Stream, New York
Long Island Jewish Valley Stream is the smallest of the three projects, but it brings challenges of its own. Northwell will complete an entire interior renovation of the roughly 15,000-square-foot emergency department. It’s less complex from a construction perspective, but the team will have to navigate emergency department functions while adhering to regulations.
“We take safety and code compliance very seriously,” Tilkin says. “We have strict general conditions that all contractors are required to adhere to and are monitored on a daily basis.”
Similar to Southside, Long Island Jewish Valley Stream will have to operate as an emergency department and a construction zone simultaneously. “It all comes down to safety, making sure that everyone’s following the rules, following the codes, and creating the safest environment possible for everybody—the patients and the contractors,” Tilkin says.
As of press time, the project is beginning the design phase. While Northwell is working with E4H Architecture, the design will adhere to the same split-flow principles. “The way patients enter and work their way through the ED is going to be almost exactly the same,” Tilkin says.
Architecture continues to evolve to support new clinical processes. As Tilkin explains, healthcare is evolving—the codes, materials, standards, and industry itself changes on a fairly frequent basis. This means architects need to react just as quickly. “We are building designs into these emergency departments that can easily accommodate patient flow,” Tilkin says.
And in the process, they are changing the way emergency departments function for the better.
EW Howell is a highly experienced New York-based general contractor and construction manager specializing in four construction divisions: Healthcare, Arts & Culture, Retail/Hospitality, and Education. For 125+ years, EW Howell has been building highly visible, complex projects on-time, on-budget, and with as little fuss as possible. The projects aren’t simplified; our process is.