Facility Space Planning for

Emergency Department

Using Simulation Analysis

SHS ConferenceFebruary 2004

Lillian Miller

Agenda

• Foote Hospital

• Emergency Department

• Facility Space Planning

• Simulation

• Design

Albert Kahn Associates, Inc.

• Architecture and Engineering firm

• 100+ Years Experience

• Quality Commitment

• Strategic Facility Planning

Albert Kahn Associates, Inc. Life Cycle of Facility

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

StrategicFacilityPlanning

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

StrategicFacilityPlanning

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

StrategicFacilityPlanning

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

StrategicFacilityPlanning

StrategicFacilityPlanning

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

Fac

ility

Man

agem

ent

Pre-DesignService

FacilityManagement

Services

Architecture &Engineering

Services

PostConstruction

Services

Real EstateDevelopments

MoveManagement

SiteManagement

Budget &Estimating

Programming& Planning

OperationsPlanning

Interior Design

Program &ConstructionManagement

Commissioning& Start-upOperation &

Maintenance

Asset Management& Financing

OperationsAnalysis

BusinessPlanning

Progr

am

Man

agem

ent

StrategicFacilityPlanningFacilityPlanning

Foote Hospital

• Health System• Jackson, Michigan• 325 beds• Major Services:

– Behavioral Health– Cancer Center– Birthing Center– Heart and Lung Services

Emergency Department

• Two EDs in Area• Level II Trauma• Built in 1983• 20 ED Beds• 34,000 Visits

Capacity• 50,388 Visits in

2000

Facility Space Planning

• Needs Assessment

• Operations Analysis

• Space Needs

• Layout

Triage ED BedPhys Sees

PtNurse Sees

Pt

Order Lab?

Lab Test

Dispo DischargeAdmit

Yes

Order Xray?

Xray

Order Procedure?

Procedure

Order Med?

Medication

No No No No

Yes Yes Yes

Ambulance

Stretcher

Nurse

Doctor

Tech

Wait for

Result

Leave ED

Simulation

• Data Collection

• Model Development

• Outcomes Analysis

• Bed Needs

Design

• Space Program

• Cost Estimate

• Alternative Designs

• Future Design

• Schedule

Facility Space Planning

Needs Assessment• Team Development

• ED Tours

• Available Space

• Town Meeting

• Codes and Regulations

Facility Space Planning

Operations Analysis

Obtainmarket study

Gather data

Tour facilityAssessment

Determinecurrentcapacity

Determinespace needs

Facility Planning

Interview keypersonnel

130.0

169.5

153.5

141.8138.0

117.5

128.4

136.0

147.2

162.5

139.1

176.5

159.9

147.7147.1

100

110

120

130

140

150

160

170

180

190

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Facility Space Planning

Space Needs• Average and

Peak Volume• Key Rooms and

Dept Space• Trends and

Benchmark• Alternative

Processes

Facility Space Planning

Layout• Gaming Board

• Initial Layouts

• Beds

• Support Space

Simulation

Analysis

ProblemIdentification

ModelDevelopment

Data Collection& Analysis

ModelValidation &Verification

ScenarioDevelopment

ResultsAnalysis

Presentation

ProcessDefinition

Simulation

Data Collection• Arrival Rates

• Resource Schedule

• Patient Types

• Activity Times

• Decision Points

0

1

2

3

4

5

6

7

8

9

10

0:00

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

17:00

18:00

19:00

20:00

21:00

22:00

23:00

Hour

Patie

nts

Simulation

Model DevelopmentRN Triage & Quick Reg

Acuity 1 or 2 to Bed

RN EvaluateMD DO

Eval and Write Order

PA NP Eval and Write

Order

Arrive

Pre-Advance Orders

Clk Enter Orders

Clk Pull Records

Clk Call Ancillary

Tech Lab Tech X-rayRN/Tech

ProcedureRN GiveMed IV

Wait for

Results

MD DO Disposition Decision

Clk Call Consult

MD DO Talk to Consult

Clk Call for Transfer

RN TransferMD DO

TransferClk Call for

AdmitRN Admit

MD DO Admit

RN Discharge

Wait to Leave

Leave ED

Clk Complete

Reg

Dispo Type

TransferAdmit

Discharge

Ambulance

Stretcher

RN

MD DO

Tech

Clerk

Clinic

PA NP

Stretcher2 Stretcher3Clk Enter Pre-Adv Order

Wait for CallBack

Addtl Order

Chart

Merge

MD2 off duty

MD3 off duty

Sched

RN off duty

RN3 off duty

Tech off duty

Tech3 off duty

Clk off duty

Clk2 off duty

Clk3 off duty

Hr Of

Day

Term

Med Rec

Ancil Lab X-ray Proc Med

Call

MD DO Discharge

Repeat

Take to Minor Trt

Rm

No

Yes

PA NP Discharge

Minor TrtYes

No

Yes

ImmedBed

Acuity 2 to Bed

Acuity 4 or 5 to Bed

Acuity 3 to Bed

Terminal

MD DO 2

MD DO 3

NP PA Chart

MD2 chart1

MD2 chart2

MD3 chart1

MD3 chart2

MD1 chart

ClinicExamRm

Clinic Leave

Clinic Open

CDU Beds

CDU Leave

CDU Decisio

n

CDU

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Hour of Day

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Simulation

Outcomes Analysis• Patients in ED

• Beds Filled

• Length of Stay

• Interim Times

• Bottlenecks

• Desired

Simulation

Bed Needs

Scenario Year 1 Year 5 Year 10Far

Future

Routine Process 29 32 35 39

Faster Process 27 28 32 35

ED with

CDU & Clinic

29 31 35 40

• By Visit Growth

• By Process Scenario

Design

Space Program• Room Types

• Room Quantity

• Room Area

• Listing

• Net Sq Ft

• Building Factor

• Dept Gross Sq Ft

Room or SpaceQty. Area Total Net Sq. Ft.

Category 1 (High Acuity Level)Exam/Treatment Room 4 230 920Trauma Room 4 250 1,000Isolation/Treatment Room 2 230 460Isolation Ante Room 0 60 0Cardiac Room 1 250 250Nurse Station 1 400 400Pyxis Machine Alcove 3 25 75Patient Toilet 2 55 110Staff Toilet 1 55 55Pneumatic Tube Station Alcove 1 15 15Stretcher Alcove 2 25 50Equipment Alcove 2 115 230Crash Cart Alcove 1 15 15

Subtotal: 3,580

Room or SpaceQty. Area Total Net Sq. Ft.

Category 1 (High Acuity Level)Exam/Treatment Room 4 230 920Trauma Room 4 250 1,000Isolation/Treatment Room 2 230 460Isolation Ante Room 0 60 0Cardiac Room 1 250 250Nurse Station 1 400 400Pyxis Machine Alcove 3 25 75Patient Toilet 2 55 110Staff Toilet 1 55 55Pneumatic Tube Station Alcove 1 15 15Stretcher Alcove 2 25 50Equipment Alcove 2 115 230Crash Cart Alcove 1 15 15

Subtotal: 3,580

Proposed

Design

Cost Estimate• Renovation

• New Construction

• Permits and Lab Testing Fees

• Furniture, Furnishings, and Equipment

• Architectural/Engineering Fees

• Contingencies

• Escalation

Design

Alternative Designs

A. Do Nothing

B. Minimal Renovation

C. Expand Horizontal

D. Further Expand Horizontal

E. Expand Horizontal and Vertical

OPTION C OPTION D & E

NSITE PLANEMERGENCY DEPARTMENT RENOVATIONS

OPTION A & B

H

EXI STING HELIPAD

EXISTING HOSPITAL

WALK - IN

ENTRY

MAI N LOBBY

SECURE PATI ENT ENTRY

EMS ENTRY

H

MAI N LOBBY

EMS ENTRY

WALK - I N

ENTRY

EXI STING CANOPY

EXI STING HELIPAD

EXISTING HOSPITAL

H

MAI N LOBBY

EXI STING CANOPY

EXI STING HELIPAD

EXISTING HOSPITAL

WALK - IN

ENTRY

MAI N LOBBY

SECURE PATI ENT ENTRY

EMS ENTRY

OPTION C OPTION D & E

NSITE PLANEMERGENCY DEPARTMENT RENOVATIONS

OPTION A & B

H

EXI STING HELIPAD

EXISTING HOSPITAL

WALK - IN

ENTRY

MAI N LOBBY

SECURE PATI ENT ENTRY

EMS ENTRY

H

MAI N LOBBY

EMS ENTRY

WALK - I N

ENTRY

EXI STING CANOPY

EXI STING HELIPAD

EXISTING HOSPITAL

H

MAI N LOBBY

EXI STING CANOPY

EXI STING HELIPAD

EXISTING HOSPITAL

WALK - IN

ENTRY

MAI N LOBBY

SECURE PATI ENT ENTRY

EMS ENTRY

Design

Future Design

Design

Schedule• Phases I and II• Approvals• Pre-design• Schematic Drawing• Design Development• Construction Documents• Bid & Award• Construction

Project Statusand

Questions