SMART INFRASTRUCTURE: The roof overhang protects the south facade from direct sunlight during the hottest part of the day. Air is brought in from low windows while operable clerestory windows and openings in the ceiling allow warm air to escape. Basic fans in the plenum facilitate air movement.

Manuel Hernandez, MD, MBA, FACEP, CPE has authored an article exploring “Low-Fidelity ED Design Solutions” in the latest issue of Emergency Physicians International. Cognizant that many of the best practices and latest trends in emergency department design heralded by developed countries are often not financially, logistically, or physically feasible in the developing world, Dr. Hernandez explores how “frugal innovation” can be used to help with issues related to patient access and communications, medical decision-making and diagnostics, and supply management among others topics. Below are key excerpts:

On redefining patient access:

Phone calls, mobile technologies with clinical capabilities, and real-time “virtual” appointments can all help assess patients’ need for emergent care well before they arrive in the ED….. The advantages to this approach are clear: in remote and resource-limited environments, leveraging tele-technologies can reduce unnecessary ED visits with concomitant reductions in overall cost of care delivery, as well as patient inconvenience stemming from excessive travel distances and diagnostic delays.

On the untapped potential of low-cost technologies:

Even when whole blood for laboratory analysis is required, low-fidelity innovation can play a role. In many resource-limited environments, technologies as simple as a blood centrifuge are limited in availability. In others parts of the world, the equipment is available but the power to operate it is either absent or unreliable. Seeking a solution that will provide reliable capabilities in these environments, a team of undergraduate students developed a hand-powered centrifuge designed from a “salad-spinner,” hair combs and a round plastic container, all assembled using hot glue. Using a reader card adjusted to the outputs of the hand-powered centrifuge, the technology provides packed cell volume measurements that correlate with conventional centrifuges.1

On designing underlying ED infrastructure:

Simple design solutions can support better environments of care. Naturally-ventilated architecture can be designed to respond to both warm and cool environments. Well-placed windows and skylights can afford natural lighting and cross-ventilation. Water collection and storage devices can hold rainwater run-off for medical and non-medical use, while shaded courtyards can pull natural light deeper into a building while providing shaded areas for patients and staff, and cooler air to support internal building ventilation. Each of these solutions can be enacted without electricity and without access to running water.

1Brown J, Theis L, Kerr L, et al. A hand-powered, portable, low-cost centrifuge for diagnosing anemia in low-resource settings. Am J Trop Med Hyg. 2011 Aug 1;85(2):327–332.

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