Efficiency and Teamwork in Emergency Departments: Perception of Staff on Design Interventions

Comparing perceptions of operational inefficiencies among clinical healthcare workers by professional role

Operational inefficiencies remain a critical occupational burden to clinical healthcare workers, contributing to adverse organizational and employee outcomes. Perceptions of these inefficiencies likely vary across occupational roles, yet these differences have not been thoroughly explored in the healthcare setting. To address this gap, inefficiencies at work were self-reported by 1083 interdisciplinary clinical healthcare workers within a large academic medical center in the southeastern United States. A qualitative inductive thematic analysis was used to describe employee perceptions of work tasks, processes, or systems that seem duplicative, poorly designed, or unnecessary. Matrix coding was used to explore differences based on professional roles. Specific inefficiencies were differentially experienced across professional roles, including but not limited to role definition, education, and staffing. The reported differences highlight the need to engage with all healthcare workers to enhance the experience of all roles across the organization.

Adapting to Change: A Systematic Literature Review of Environmental Flexibility in Emergency Departments

PURPOSE

This study aimed to offer a comprehensive analysis of distinct design strategies identified, evaluated, or discussed in the existing literature that promote environmental flexibility in the context of emergency departments (EDs).

BACKGROUND

EDs are subject to constant changes caused by several factors, including seasonal disease trends, the emergence of new technologies, and surges resulting from local or global disasters, such as mass casualty incidents or pandemics. Thus, integrating flexibility into ED design becomes crucial to effectively addressing these evolving needs.

METHODS

A systematic search was conducted in four databases: CINAHL, MEDLINE, PubMed, and ScienceDirect, in addition to a hand search. A two-stage review process was employed to determine the final list of included articles based on the inclusion criteria. Included studies were evaluated for quality, and findings were categorized using a hybrid deductive and inductive coding approach.

RESULTS

From the initial yield of 900 records, 22 studies met the inclusion criteria and were included in the final full-text review. The identified design strategies were organized into five categories: modifiability (n = 13 articles), versatility (n = 8 articles), tolerance (n = 6 articles), convertibility (n = 4 articles), and scalability (n = 7 articles). Specific design strategies under each category are reported in detail.

CONCLUSIONS

Our findings suggest that most flexibility design solutions are based on anecdotal evidence or descriptive studies, which carry less weight in terms of reliable support for conclusions. Therefore, more studies employing quantitative, relational, or causal designs are recommended.

How Visibility May Reduce Security Issues in Community Hospitals' Emergency Departments

This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs.

METHODS

How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry.

RESULTS

The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility.

DISCUSSION

This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.

Study on value-based design of healthcare facilities: Based on review of the literature in the USA and Japan

With limited medical resources, it is of great significance for countries all over the world to explore architectural design methods to enhance the value of medical facilities. Therefore, it is very necessary to carry out an extensive international comparison. In order to grasp the research trend of healthcare facilities in the world, this paper conducts co-occurrence analysis, cluster analysis, and trend analysis of the keywords of 334 English articles and 153 Japanese articles related to healthcare facilities published in important academic journals in the USA and Japan in the past 15 years. We not only compare the similarities and differences in healthcare facility research between the USA and Japan, but also explore the reasons for these differences. It is found that by introducing three kinds of value variables, such as time, space, and behavior, we can not only well explain the difference in the solution of healthcare facilities in the USA and Japan to reduce medical costs but also provide new ideas for architectural design to enhance the value of hospitals. Based on the above analysis, a conceptual framework of value-based design of healthcare facilities that combines the advantages of the USA and Japan is proposed in this paper.

Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

BACKGROUND

Emergency departments (EDs) have been struggling with overcrowding issues for years. Some spatial configurations have been proposed to improve ED performance in facing overcrowding. Despite similarities with mass casualty incidents (MCIs), when demand for care exceeds the capacity, little is documented about the application of the proposed configurations during MCIs to improve surge capacity.

OBJECTIVES

We aimed to explore the potential of spatial configurations that have been proposed to handle ED overcrowding in daily operations so as to improve surge capacity during MCIs.

METHODS

Using an online Likert-scale survey, 11 spatial design strategies were rated by ED care teams in terms of their potential to improve surge capacity during MCIs.

RESULTS

Responses from 72 participants revealed that establishing an in-house lab was perceived as the most potential strategy, followed by rapid care area, internal waiting rooms, and in-house imaging. In contrast, separate entrance and exit doors, as well as decentralized nurse stations, were perceived as the least potential strategies but also exhibited the most variance in response. Respondents' comments implied that their choice of in-house ancillary services was primarily to improve communication and to reduce turnaround time and risk of errors. Their choice of rapid care and internal waiting areas related to improved flexibility.

CONCLUSIONS

Understanding clinicians' perspectives on potentially effective spatial configurations aids in implementing balanced strategies to better equip EDs to handle overcrowding in daily operations and manage surges during MCIs.

Drive-Through Urgent Care Centers: Could They Be the Future of Healthcare Facilities?

OBJECTIVE

This study assessed the perception of people toward drive-through healthcare services, their willingness to use them, and the scope of services they would like to receive in a post-pandemic world.

BACKGROUND

The abrupt spread of COVID-19 urged healthcare facilities to adopt new infection-control measures. Drive-through testing facilities were implemented as one of the measures to minimize physical contact between healthcare workers and test-takers. Many studies describe drive-through models' merits, but people's opinions about them as a permanent attachment to healthcare facilities are unclear.

METHODS

An online survey was distributed through snowball sampling. The survey solicited feedback from adults who lived in the United States. The survey consisted of Likert-type and multiple-choice questions and was completed by176 eligible participants.

RESULTS

The use of drive-through pharmacies increased after the spread of COVID-19. Most people agreed drive-through healthcare services could be more convenient and safer to use. People prefer to have their vitals checked, and vaccinations received in a drive-through because of the improved infection-control matters and increased comfort; however, they are neutral about the level of privacy they have and the hygiene of drive-through healthcare settings.

CONCLUSIONS

This study shows permanent drive-throughs offering medical services benefit people in times of crisis for the perceived infection control purposes and the improved convenience. A drive-through model can redefine the waiting experience and serve as a new safe triage system in urgent care centers. Drive-through urgent care centers can be adopted as a hybrid of telemedicine and in-person visits.