facility space planning for emergency department using simulation analysis shs conference february...
TRANSCRIPT
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