Making a resilient and flexible emergency department to handle community needs and crises

Flexpod2 Hero2 Update

Brian Silva and Ellen Leise

July 11, 2024

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Emergency department staff never know who will walk through the doors and what kind of issue they’ll need to contend with. It could be anything ranging from a gunshot wound victim to someone dehydrated from the flu to a person with a bevy of symptoms that aren’t adding up.

As the healthcare landscape continues to shift and evolve in the United States, so is the scale of illness, injury and community support managed by emergency departments (EDs) across the country. With crisis like the coronavirus pandemic, the mental health epidemic, ongoing violence and more, these facilities are often pushed to their limits, resulting in longer wait times, overworked staff and less than optimal patient care.

UC Health’s Emergency Department, a Level 1 Trauma Center in the heart of Cincinnati, is using lessons learned from the pandemic and other large-scale crisis events to create a one-of-a-kind Rapid Response Flex Pod. The space, adjacent to the main ED, can easily expand or contract to accommodate anything from a community recognition ceremony to a mass casualty situation to another pandemic or infectious disease scenario. 

Testimonials

  • The built environment cannot be a static monument that can’t evolve or change with the needs of healthcare.

    Dr. Ben Bassin Emergency Medicine physician at the University of Michigan and Blue Cottage of CannonDesign Innovation Fellow

“The built environment cannot be a static monument that can’t evolve or change with the needs of healthcare,” said Dr. Ben Bassin, an Emergency Medicine physician at the University of Michigan and a Blue Cottage of CannonDesign Innovation Fellow who was part of the UC Health design team. “The environment needs to be dynamic, flexible and resilient.”

The flex space’s origin partly ties back to two formative crisis events it experienced in the last four years.

Like many emergency departments and hospitals, UC Health had to improvise when confronted with the sheer number of patients needing care early in the pandemic. They constructed drive through testing sites on their campus, created more infectious disease inpatient units in the hospital along with many other adaptations created out of urgent need. Contactless check-in, socially distanced waiting rooms and changes to HVAC systems are other here-to-stay healthcare adaptations.

In January 2023, Buffalo Bills football player Damar Hamlin collapsed while playing the Cincinnati Bengals. After being resuscitated from cardiac arrest, he was taken to UC Health in critical condition, and he remained hospitalized for nine days. Media from all around the country camped outside the hospital, providing live updates from the emergency department parking lot throughout the duration of Hamlin’s stay at the hospital. This created logistical hurdles and frustrations for emergency vehicles trying to drop off critical patients, and for those driving to the ED on their own.

Lounge Space Layout

Flexpod2 Lounge Space Update

When there is no acute community crisis or infectious disease incident, the flex space can be used as additional waiting space for the main ED and also as respite space for staff. The separate flex pod entrance is closed off and it is only accessible through the main ED.

Community Event Layout

Flexpod2 Community Event Update

A community event could be a mass shooting incident or other mass casualty event. The separate flex pod entrance is closed off and all individuals go through security screening in the main ED before patients are given a room and family members and other personnel are placed in the flex space. All other entrances to the flex space are closed.

Emergency Management / Pandemic Layout

Flexpod2 Emergency Management Update

In the Emergency Management iteration of the flex pod, such as in a pandemic scenario, the entire Rapid Response Care Space is activated (aqua area). Patients are screened in a vestibule area near the main ED entrance and in infected patients, moved into the flex care space. Patients can easily be transferred into the main ED if more complex care is needed.

The goal of the flex space, says Brian Silva, one of the lead designers and planners of the project, is to allow the ED to safely handle crises such as those that tested UC Health recently while still letting the main ED function normally. It was designed with the intention to handle incidents such as an emergency responder injury, a community event such as a mass shooting, an infectious disease scenario and an assembly space for events or press conferences. Day-to-day in non-crisis situations it will act as a lounge space for those waiting for test results or patients to be discharged or transferred.

“Ultimately the space looks to simplify what is actually a complex program,” says Silva. “But its main functions are people management, emergency situation management and to allow for bigger assemblies on campus, all without disrupting patient care and flow throughout the ED and beyond.”

To accommodate varying levels of patient acuity and demand, up to 50 patients can be treated (in addition to regular ED capacity) in divided care bays. Hidden behind discreet removeable panels are medical gas devices and emergency power outlets, allowing for higher levels of care and flexibility to address minor to major injuries and illness.

Uc Health Flex One
A rendering of the Emergency Management setup, where patients have individual treatment bays and clinicians have line of sight to those in their care.
Uc Health Flex Two
When there is no active community crisis or large-scale medical event, those waiting for patients being treated in the ED can use the space. It can also be used as staff respite or meeting space.

“The flexibility not only of the headwalls but also the furniture and equipment storage is crucial for how quickly this space may need to be activated, and how a patient’s status can change in an instant,” says Ellen Leise, another healthcare planner on the project.

The space is projected to open in August 2024, and because of its flexibility it can easily respond to staff and patient feedback after its initial uses. UC Health received local, state and federal funding for this project as it will benefit the readiness of this Level 1 Trauma Center to better serve the community with a future-proof, resilient facility. The different space activation methodologies and crisis scenarios will be folded into regional readiness training for emergency scenarios and serve as a nationwide example.