The future ED is all about automation, robotics, and personalized experiences.

Hernandez Discusses Future “Post-Lean” ED Design

In the future, a human being may never touch a specimen in the clinical laboratory unless there’s a problem.

“The innovations that we create have to be tied to what is realistic and practical within a community and within a healthcare system.” That was a key take-away in a recent Emergency Physicians International interview with Manuel Hernandez, Global Health Practice Leader at CannonDesign. Over the course of the interview Hernandez discussed everything from the facility innovation coming out of Scandinavian countries to how some of the same thinking that propelled the move from standardized to personalized medicine is changing the approach to emergency department (ED) design as well. Highlights include:

On What Scandinavian Countries are Teaching Us

Akershus University Hospital, in Oslo, is now about seven or eight years old, and when it opened it was the most technologically advanced hospital in the world. They spent a lot of time thinking about the interplay between technology and the physical environment, the workforce, and patient experiences, and designed from the ground up a solution that really focused on technology as an enabler of efficiency and quality within their institution:

  • The clinical lab in Akershus is a completely automated robotic laboratory. A human being never touches a laboratory specimen in that department unless there’s a problem with the specimen and it’s rejected by the automated line…This results in what is probably the most efficient clinical lab in the world.
  • At Akershus, they use what are called automated guided vehicles (AGVs) throughout their entire hospital. They are driverless delivery modules that can deliver supplies, logistics, food—pretty much anything—from the point of origin to the point of need without having to have a human push those carts around. This creates a lower labor cost, which is important in markets where resource availability is an issue.
The “Post-Lean” ED: At CGH Medical Center, a low-acuity zone with lounge chair stations allows low-to-moderate acuity patients to flex into this area from triage or from the main ED.

The “Post-Lean” ED: At CGH Medical Center, a low-acuity zone with lounge chair stations allows low-to-moderate acuity patients to flex into this area from triage or from the main ED.

On the “Post Lean” ED

We’re evolving into a model of streaming and/or parallel processing, in which we focus more on function and focus less on place. Practically speaking, that means we eliminate the notion that every patient has to experience their process in the ED the same way. Rather, we’re tailoring that experience and the processes the patient needs to go through to match the patient’s true needs

You can see that play out from a facility perspective by rethinking the entire patient arrival experience, and moving away from traditional triage rooms, waiting rooms, and space for things like patient registration. We’re moving towards intake zones and care initiation zones and differentiating between patients who need a bed or a trolley and those patients who can remain upright in a chair.

On the Impact of Telemedicine in the ED

On the patient experience side, it is about making sure that the rooms are laid out and sized to support the telemedicine technologies. Most of the technologies have become mobile, so you can wheel those pieces of equipment into the room and position them next to the patient. Some departments are beginning to explore wiring  telemedicine technologies into the room itself.

Many EDs with training programs already videotape a resuscitation and use that as a teaching tool after the fact. Now it’s possible to utilize similar technologies so that you can have a physician watching the resuscitation managing the patient remotely, with the ability to zoom in and look at the patient, listen to the exam as it’s being completed, to move the camera over and look at the cardiac monitor and the blood pressure readings and the ventilator settings, and to actively assist in directing the resuscitation of that patient. That’s a very, very new innovation that is beginning to evolve.

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