Howdy.

So thank you.

Roxana.

My name is Victoria Villareal and I am a medical planner with Smith Group in Houston.

I'm also a very proud Aggie.

I completed both my undergrad and my graduate degree here.

And this lecture series actually set me on a path towards a career in healthcare architecture.

So it's very, very special for me to be here today along with my colleague.

And I'm delighted to share what we've all.

Hi, I'm Erica, for sure.

I'm a senior medical planner with this group, and I work out of our Phoenix office.

So like Victoria and probably some of you in the audience, I found my passion for healthcare when I was in college as well.

Through a series of internships that I did, I was able to get experience in healthcare design and just absolutely fell in love with it.

I really love, the challenge of it.

You know, there's so much to learn.

It's always changing.

And at the end of the day, I feel like I'm really making an impact on my community.

I wanted to just share a little bit about Smith Curve at large.

So for those of you who aren't familiar with our firm, we are a fully integrated architecture and engineering firm, which means that we have a lot of disciplines beyond architecture.

So architecture is our largest practice.

I think we have over 600 architects out of our 1600 employees, but we do have mechanical, electrical, plumbing, landscape architecture, interior design, fire protection, lighting, sustainability, civil engineering.

I'm sure I forgot someone, but we have pretty much every specialty in one room, which is wonderful for us.

We're also, as you can see, very spread out geographically across the country.

And so what that allows us to do.

Right?

As Victorian, I've been working together on a project this past year.

It allows us to make connections and work with clients in other locations that maybe we otherwise wouldn't get to.

And also lets us bring kind of our best skills to each of those clients.

So you can see, all of our 1600 people, more than 20% of us are dedicated professionals working in the healthcare industry.

And we're also really proud, you know, like your university history, we have a very long standing history of being continuously operating for over 170 years.

So these are some of the markets beyond healthcare that we are in.

While that is one of our larger markets, we also have a huge presence in science and technology.

We have a cultural studio.

We've done a lot of museum design, mixed use commercial corporate interiors, civic work in the planning front.

I, oversee we've got health planning, lab planning.

We also have campus and urban planning.

So planning at very different scales.

These are just some of the many different types of work that we do across our firm.

Today our agenda is pretty simple.

We wanted to share with you guys a little bit about emergency department design in general, but really our focus is to share with you a really special and unique project, something that even, you know, as I've advanced in my career, I've never quite seen a project like this until I encountered it.

And so we wanted to just share that with you and talk along the way about traditional, emergency department design.

And then our unique approach on that project and that work.

So now I know the slide says emergency department, but let's start somewhere else, maybe someplace we're all a little bit more familiar with Kyle Field.

So Kyle Field on game day is really the front door to the AG experience.

Thousands of people pour in and every system from traffic to safety really has to work seamlessly or the whole experience is at risk.

Now the emergency department works a little in the same way.

It's the hospital's front door.

It's built around for safety, but a response.

Every zone has a role, and it really depends on how well the EDI manages that first touchpoint.

So we know that you guys obviously have exposure to health care, but we wanted a level set, some terminology that we use in health care and specifically with the emergency department.

So we're going to touch on these as we go forward.

But acuity level is kind of what it sounds like.

It's, you know, how ill or how sick is the patient.

And within an emergency department, every patient is graded kind of on a level 1 to 5.

And right off the bat that means that they may go through a different flow.

Right?

A patient who's coming in emergent via ambulance needs very different care than if I walk up and, you know, I'm just nauseated and maybe need some quick medicine.

The next is throughput.

That's a concept that absolutely influences us on health care, on the clinical side, our clinicians are constantly being pressured to see patients faster, right?

Reducing waiting times.

And so especially in an age where things are can be very chaotic.

And we're in kind of crisis management mode, we want to be as efficient as we can.

And so that will impact how we design the space on stage.

Off stage is maybe a term.

You've also heard.

But really essentially it's a way for us to provide, our public facing kind of improved experience for our patients and public and then a more private and secure experience for our staff.

And we'll talk about that.

How that influenced the design of this project is exactly kind of what it sounds like.

It's those lower acuity patients, patients we want to see, and we want to turn them quickly, centralized versus decentralized.

So that can be a number of different things.

It may be how the staff are working.

Right.

Are they all clustered or are we working at point of care?

Or how are supplies either centralized or distributed, you know, throughout a space.

And then the last one that we will touch on in this case study is the term observation.

So observation is kind of an in-between, I'll say level of care.

If I present at the Ed and maybe I've got some cardiac issues and they want to monitor me, but they don't want me trying out for an acute care, you know, exam room.

But I'm not sick enough to go to the med surg unit, so I'm somewhere in between.

And how do we deal with that.

And it all goes back to kind of improving throughput.

So we'll touch on the design of those spaces as we go through this.

And now that we're all aligned on key terminology, let's take a look at the emergency department and really how it connects to the rest of the hospital.

The diagram on the screen highlights the most critical connection points and the solid arrows.

You'll see high priority direct access routes, and then the dashed arrows will indicate things that happen, maybe through staff corridors or public spaces.

They're still important, but the proximity maybe doesn't need to be as important.

So we'll start here since the arrows show us which connections are the most critical.

Let's start first with priority how people are actually arriving.

So the ambulance and helipad are two primary entry points into the, emergency department.

Both require direct and quick access.

Moving on beyond emergency arrivals.

But it also depends heavily on the daily support functions of departments such as pharmacy and materials.

Adjacencies are essential to keeping this department supplied and operating efficiently.

And then once a patient is in the Ed diagnostics and short term monitoring, really drive the next steps in what that care going to look like.

So for this reason, the adjacency to imaging and observation is critical in those early planning phase phases.

And you'll hear us talk about that quite a bit throughout our presentation.

And then finally, not every patient stays in the emergency department.

The patient elevator here is really a gateway to those other connecting departments, such as surgery, med surge in the ICU.

The patient elevator also provides direction up to the helipad so patients can quickly be transferred out.

If for some reason a higher level of care is needed and it can't be provided at this facility.

So with the connections in mind, the next step is really understanding how people move through the department.

So we're going to start with walk up patient.

Let's walk up.

Patients are going to enter through the vestibule, move their intake and triage and then be directed over to a treatment space.

Alternatively patients could arrive via ambulance and they can be directed in several different directions depending on their condition and acuity.

And the last part that we'll look at here is the staff circulation.

So the staff circulation, it links treatment support observation spaces and the layout of the department really should balance efficient staff movement and good visibility across all the patient areas.

I remember one of my first experiences walking in an ad.

Thankfully, I was not an emergent situation.

I was with a client, but it really is like a team building.

Things are moving quickly.

It's rapid.

You have folks being treated, you have folks being treated, staff moving around.

So that circulation and flow is really, really important in this type of environment.

So now that we have flow in mind, let's take a closer look at the core functions inside that emergency department.

So what you're looking at here we're going to essentially build an ID.

So starting at the front end we typically see spaces like waiting registration public amenities, areas that really set the stage for how patients and visitors first experience their care.

And as we move past the front end entry spaces, we arrive at the core treatment areas.

Here, the rooms function, for a variety of things.

They range from low acuity to standard treatment rooms to areas where patients are maybe waiting for results, and all the way up to potential trauma care.

Now, connections to supporting departments are critical to efficient EDI design.

So the diagram here highlights the links in the early planning.

It's really important to think about how these functions work together blocking wise, but also stacking, right.

We want to have strong connections across departments vertically throughout the building as well.

So viewed all together, these core functions remind us that the EDI is more than a collection of rooms.

It's a really carefully planned system where relationships and adjacent adjacencies really drive that performance.

So with that, I'll turn it over to Erica to share a little bit about how emerging trends are shaping our EDI design today.

So as designers, you know, beyond the physical space, right, that we all learn and understand, it's important for us in healthcare to understand the stressors and challenges that our clinical operators are facing.

And these are some of the recent, you know, and this is over several years, but some of the increases of stressors we're seeing, right?

So we all know there's a kind of behavioral health crisis, and we're seeing more and more people who need behavioral health care.

And the EDI being the front door is usually the place where those those people present in times of crisis.

And so how do we manage that?

Right, given all the other stuff they need to take care of?

Our clinical operators, again, are busy with improving patient outcomes.

So essentially us as designers, we're almost being charged with helping to support that process.

Right.

And then since the pandemic, right, nursing and staff burnout, shortages in working, of workers and increase in violence or aggression against staff has been an ever present concern.

And then, you know, just the uptick of people are becoming sicker and sicker.

We're seeing more rise, you know, increase in volumes and wait times.

So what can we do as designers, right, to help support and address these.

So these are some design responses.

These are specifically things that we are actually going to talk about today.

But creating behavioral safe safe space for our behavioral patients within the emergency department.

We're also going to talk about I mentioned the on stage off stage model.

But how can we really use that model to reinforce the staff safety but also improve the experience for patients, lower acuity patients.

And so again, about that throughput and kind of rapid movement.

How can we take care of those patients that maybe should have gone to urgent care or even their primary care, but they're presenting it for a number of reasons.

And what can we do?

And then lastly, the the observation space that we talked about, kind of that middle ground, we need to be close to EDI.

We need EDI care.

But we're not ready to go anywhere else yet.

So you knew it was only a matter of time before Kyle Field showed up in this presentation?

Again in this game here.

So as most people know, Kyle Field is more than a stadium.

It's the front door experience to Ag1.

And the 12th man is more than a tradition.

It's the spirit that fills that stadium.

What makes Aggie Land special isn't the stadium or the place.

It's really the people, right?

We stand, the whole game and I love that.

Ready, united and unwavering.

And that spirit really defines Texas A&M.

With that being said, in the same way, the case study we're about to share is rooted deeply in community.

The hospital reflects the culture, resilience and value that its people.

And just as the 12th man reflects the heart of Aggie Land, we're going to share a little bit more about this project.

Yeah, so these are really three overarching influences on this project that really, set this apart and made it a unique example as you'll start to see, we're in a very rural setting, which means their access to higher levels of care, you know, supporting kind of adjunct functions out outpatient support services is very limited.

And so unlike, you know, a very urban setting, we're going to talk about stressors that are pretty unique to, to being in a rural environment, culture is a huge component of this.

Well, I'm not going to go into the specifics of the culture for this project, but, the cultural influence influences everything from, you know, how we ordered the building where the main entry was located, what types of design elements and finishes we had throughout.

And then for us, you know, programmatically what spaces we needed to have.

And we're going to talk about one in particular that influenced the ad.

And then again, the the community influence of, of the community at large and what that meant.

So I guess that's a good segue.

This is an image of the project we just completed, design, I guess, just for some scale for you guys.

It's about a 400,000 square foot replacement hospital, which means there's an existing hospital on the site that we need to maintain operations of while we're constructing the new and multi-specialty clinic all in one, which is, not exactly a common typology.

There's a lot happening within this building, as you'll see, but also with that, this really, is largest in scale and largest in height, for this community, largest building in height and scale for this, this community within this area.

And so that really influenced kind of where we went as we started to do our conceptual exploration.

We know that we need an efficient, you know, acute care component, right?

We want to we want to be efficient and provide great care and best practices.

And we also know we're providing these outpatient services and preventative medicine and other community services.

But there was this layer of community amenities that we wanted to use this as an opportunity to create almost a destination.

I was telling Victoria that the staff talked a lot about Taco Tuesdays.

Like that is one of, you know, this is one of the few places in this area where you can get lunch, and everyone loves the tacos and they want to come here.

And so how could we play into that, right.

And really support the community at large with our building?

At a at a glance.

We don't need to memorize this, but essentially this is our program break down.

So I mentioned we have all the acute care functions you might typically see.

Right.

We have an emergency department imaging surgery labor and delivery.

And our acute care unit.

But we have a lot of outpatient services.

So we've got just normal outpatient specialty care outpatient preventative medicine, wellness.

And so all of that under one roof, you know, created a unique set of challenges that we had to work around.

And we did that in our stacking.

So right off the bat, we looked at, you know, how can we put all this together yet provide very much like clarity for our patients as they're arriving?

And so what you'll notice is we ended up with a four story stack.

All of our acute, care services are on the west side or left side of the floor plan.

And so you've got Edie above that surgery, above that acute care, and then another floor for future expansion.

And then finally with helipad directly on top.

So very efficient on the right side of our building where all of our outpatient services.

And then we split the building on levels one and two, and we had this nice kind of plaza that helps lean into some site sloping.

We had, and really helps to brand those entry points.

So this is an image or kind of a view.

As we're arriving on site, you can kind of see it's one continuous building that splits at the base, of the building.

And then as patients come in kind of central to that site, then they will reach kind of a decision point in the center.

And either they're going right over to the wellness portion of the building or staying kind of direct ahead into the main entry, or they're going to go left over to the emergency department.

And so this site diagram I think highlights those those key entry points.

Right.

So I talked about the wellness outpatient entry.

So very clear kind of organization I'm here just to get my teeth cleaned going into that entry point.

The main entry into the hospital and then the walk up entry to the west.

What I will say is throughout all this and you'll see this, there is a connecting spine that allow public to to connect all those things, and then off of that touch into all those amenities.

And then on the far west is our ambulance entry and we'll, we'll talk a little bit more about that.

This is a little bit of a kind of slice through our floor plan, just in a little more detail.

If we look at the Ed, portion on the West, you can see like I said, there's kind of this circulation path and light yellow that kind of goes along the building.

Right.

And we'll connect patients back from Ed, like maybe my family members back there, and I need to go to dining, or I need to go pick up a prescription.

You can you can find your way back there.

And then the, you know, Victoria had talked about critical adjacency.

So the imaging department is immediately adjacent to the Ed.

And we'll we'll dive into that one a little bit more.

And then another unique aspect was the EMS.

So we know that ambulance need to drop off.

That's common for for all emergency departments.

But here the EMS for the entire region needed a home, a garage, a workspace.

And that actually is located on our site.

So again, that added another level of complexity to our site design.

So diving in a little bit more on the interior.

This is the floor plan of our emergency department.

And kind of at a diagrammatic level our walk up entry is on the South there in yellow.

And we'll talk a little bit more.

What influenced kind of our race track of our EDI treatment.

But we have what you would see kind of the usual suspects with 36 total treatment spaces, but they vary in in ranges of acuity.

So we have our low acuity spaces fast track towards the front.

We have our trauma, our ambulance entry, our, you know, typical acute care treatment and then we have a unit that we're going to talk about the EMS kind of our specialty unit, which is a combination of observation, behavioral health and ICU level care.

And lastly, of course, that imaging department connection.

I did just want to share, you know, a lot of times, especially with an EDI of the size, we might see imaging spaces embedded within the emergency departments.

You might see a CT right there.

They're doing a lot of those tests.

But here, because we are in such close proximity to imaging and just the way they wanted to operate the facility elective, to take both cities and put them kind of right on the edge of the emergency department.

So quick access for both Ed and imaging patients.

And so next we wanted to kind of let Victoria dive in to, we're going to take you guys on a journey or a tour through each of the components of RDM.

Triage is really the first point of contact for patients entering the UD.

To support this process, staff need clear visibility to the entry, reception and waiting areas to identify patients promptly, and the dual access to the triage room also enhances efficiency, so staff is able to really quickly evaluate a patient, determine acuity, and then figure out if they are going to be returned to the waiting room or if they need to be, directly treated in a space.

Design of our triage room.

And I will say there's nothing particularly unique about the design of the room itself.

I mean, our job.

Right?

And I should have mentioned this.

This facility has not had a major expansion in, like, 50 years and probably won't get one for a long time just with the way that they're funded.

So essentially, we want to be designing to the latest and greatest.

We want to bring in the best practices, knowing that maybe they're operating one way, but they maybe want to operate a different way in the future.

Right.

And so we spent a lot of time talking about, their patients who really should be going to primary care but are presenting at the Ed.

And so we're hoping to rectify that through the design.

We've got a new, very expensive primary care center.

But at the end of the day, right, we want to set this triage room up to be flexible.

Another thing I will mention, which is kind of a trend in EDS in general, we're seeing more and more and more in an effort of like throughput and really keeping those who don't need to be in the Ed in the heart of the Ed providers, moving out towards the front of the Ed and seeing patients.

Right.

So we're seeing them in triage.

In some cases, we're building even spaces almost in the waiting where providers can see patients.

So setting this up, with that in mind, knowing that we want full capability to do fully functional exams, with providers was important and moving forward to lower acuity treatment areas.

So this is not a standard area in most Eds, but when it is provided, it significantly improves patient flow.

So this unit space is designed for, quick treatment and discharge without occupying emergency spaces so that patients can get in and out.

The optimal placement is near the entry and triage, with compact exam rooms scaled for the level of care at the facility.

And what's key here, too, is a flexibility.

These rooms need to be able to flex and adapt during peak times.

Sometimes you may see recliners or stretchers in this space, really to adapt to whatever care is being provided.

So again, clear sight lines and keeping these patients separate from higher acuity zones to make it function more efficiently.

So breaking down the layout of this space, you know, it was funny.

One of the physicians would always use the term we want to treat them and treat them.

So it's about, you know, how how quickly can they see those patients.

And so each of these spaces, as Victoria mentioned, are smaller in scale.

But we did want to provide some privacy.

So there are some walls.

The image on the right shows another example where we've done more of movable walls or partitions that allow and kind of reinforce privacy, but also allow that flexibility.

And then here we really decentralize the staff work area.

So these are dedicated physicians and staff working out of this space kind of at the front end.

And ultimately the design is set up that if they need to convert these back to exam rooms, they could or we could convert other exam rooms into more abstract as their, their volumes and acuity might change over time.

And then I think just kind of stepping back to our design.

So this is something that was really unique, again, to this project.

And I mentioned at the beginning one of the stressors is concerns over workplace violence and just patient aggression against staff.

So as a part of this project, we conducted what's called a safety risk assessment.

I'm not sure how many of you are familiar with that, but it's a fairly extensive process where we look at all the risks across the project, not just in the Ed, but one that presented a lot in the Ed was that concern of staff safety.

And so we really jumped in, did a lot of research and ended up taking the client on a tour of an on stage, off stage model for the Ed.

So again, I would say in my career, this is a more unique example.

We don't frequently do dual sided Ed exams, but that is what we did do here for the primary reason of improving that patient experience, but then providing safety for staff.

So you'll see, in our next kind of zoomed in image.

So each of our primary exams we have 16 that went around that ring there around the perimeter have a public access side.

It was that yellow corridor along the outer part.

And that is how patients will be brought in that is how family members can access the rooms.

And it's a nice, let's just say, more common corridor than walking into the chaotic scene that, that Victoria experienced.

The doors will be solid, but break away so that we can take patients out to imaging or up to the med surge unit.

Family zone.

Right.

We've got support space for families in that area.

And then on the back side of the Ed, that's where we had that inner core of just all the staff support.

So clean med nourishment, you know, the dictation space, even the staff bathrooms are all self-contained in a very secured area for staff.

And they have a glass sliding door.

They'll be able to fully visualize the patients when they need to close the curtain for privacy.

And then when they come in, they have immediate access to their handwashing, computer, vitals and all the equipment that they need to care for the patients.

This portion of our project is probably the most interesting.

So I know this whole series was about hybrid and emergency department design.

I'm sort of calling this the hybrid within a hybrid.

So we have, all of that in one.

They had some really unique, I think, stressors or conditions that we had to plan around.

So they do need observation space.

They don't have the volumes to really warrant a separate observation unit.

Right.

So we want to be co-located with ADF.

They also have a fair amount of behavioral health, you know, patients that present that need to be sort of stabilized and held until they can get them to the treatment that they need to go.

So it's not a a true empath unit.

We're not treating the patients here medically, but we need a safe place to hold them.

And how can we make that safe for the patients and the staff?

And then, what also was extra unique that I had not experienced before, but because they're so rural, they don't have and they don't have an ICU here.

We just have a med surg unit.

They need to be able to provide ICU level care of a patient in med surge.

You know, something goes wrong and they need to transfer them out.

But it's snowing and they cannot get the helicopter to land for two days, which does happen there every winter.

They need a place to do that care.

And the Ed staff are really the best trained to care for that patient.

So this unit will be very flexible.

And we're going to walk through kind of how the unit design and this, you know, the space itself was designed to accommodate all those functions.

It's secured.

It has access to that support core.

But it does have a separate dedicated nurse station.

And security presence.

So diving a little bit into that behavioral safe room.

So when a patient arrives with psychological distress or crisis, they really need two things.

They need security.

And they need a comfort a calming environment that really keeps everyone involved.

Safety and safety is built in in a multitude of ways.

We utilize anti ligature doors, tamper resistant features and controlled access for staff and supplies.

These patients are under constant observation and it's really supported by durable, safe materials, and secure furniture.

So just as important, the environment is designed to also de-escalate a situation.

We encourage this by using calming finishes, sound control and when able, also incorporating natural light.

Now we're moving on to observation rooms.

Observation rooms are for those patients whose conditions may not be immediately Life-Threatening, but they needed extended monitoring to see if their symptoms change.

These rooms are designed really with visibility in mind, so we're using large windows, glass doors that allow the staff to keep a constant eye on the patients.

They also include spaces for family, usually a recliner or bench.

The key here is to really have clear separation.

So that way family is not interrupting staff while they're caring for the patient.

What's interesting too, is the head wall in this room is equipped with gases, power, all for monitoring and having flexible care.

So compared to exam rooms, the observation spaces are a little bit larger, a little bit more comfortable and more private.

I mentioned that we don't have ICU at this facility, right?

I mean, the standard protocol would be to take a patient to ICU or transfer them out.

So in this instance, there was no playbook really for how to design this.

I mean, yes, we have codes, but there is no specific ICU space.

How do we design that need to do these things.

And so we started with just our code requirements for clearances around the patient.

And those are set up because because of the equipment they're using, we need to move vents and other lifesaving equipment in and out of that room easily.

The other thing that we did is all of the head walls were designed to be ICU ready.

So that means that we're going to have a lot more gases than we would see in a typical, even exam room.

And then, you know, in conjunction with observation, we might have patients that are family members there.

So we've got, you know, the recliner to accommodate families.

And what was nice to, if you kind of go to the next slide is we started to put all of this together.

Right?

We have all three of these typologies coming together in one room that we may need to flex on a daily basis.

The observation the same window that was for observation and behavioral health is really an important part aspect of ICU.

And being able to visually see those patients so well might seem a little strange on the surface.

The unit itself is going to be able to service the unique needs of this community.

Around the common homes are for patients rushed in after a serious incident or rapid coordinated care is essential.

These spaces connect directly to the ambulance bays, and they're there for the fastest possible transfer, and they're positioned for clear visibility within that nurse station.

So inside the trauma rooms are outfitted with extensive infrastructure.

Multiple gases dealing rooms power anything to allow the full trauma team to come in and provide support for that patient.

So the layout should really provide generous room for those large teams, which is very different from some of the other spaces that you'll see in the ad.

So here we talked right there in a very remote location and similar to what we said about ICU, if I've got a trauma patient that I need to, you know, move out or I've got to move someone in because I can't transport them anywhere else, we need to be able to surge and kind of be more flexible than I would say we would be in a typical Ed.

So we designed the head walls and the room space to be able to accommodate additional patients.

So while they're set up for two, they may have upwards of four patients in this space at one time.

And how can they how can they care for all of those patients?

The other thing that was unique about this facility is just the demographics of the facility.

Meant that there was, let's just say a higher prevalence of obesity within the community.

And so we did, as a part of that safety risk assessment, really looked across the whole building to determine, you know, where do we need to add patient lives?

Because really it's all about staff safety, safe patient handling.

And where do we need to do that.

So maybe not typical, but we did add ceiling mounted patient lives.

You know, we have the surgical lights and we have the curtains for privacy.

And so there's a lot of things we had to coordinate and put together in one space.

And one of the last spaces we're going to take a look at is the bereavement space.

So in this space family members may have just received, difficult news.

And we want to be sure to give them a space that is discreet.

It's private, it's quiet where they can really gather, grieve and receive support.

So as Victoria just described, right.

That's kind of what we would typically see in.

And we've been here, it was very different.

And this is really where the cultural and community influences came into play.

When they use the bereavement space, it's not just about small kind of family grieving.

It is experiential with the patient.

The patient is brought down even from like a med surg unit would be brought down to this space.

So the entire space needed to be much larger.

We need to accommodate large groups.

They may even be performing ceremonies or things within this space.

And then thinking about that, the community aspect, the entire community is invited to this process and it may span multiple days.

So how can we do that?

Right.

This is a very landmark site.

We've got a lot happening.

EMS is over there to the west.

We got our walk up entry.

And so we really created this, outdoor processional space on the exterior.

And so we used the outside right to be able to bring people in and give additional space for gatherings.

So we'll have like a nice indoor outdoor connection through some vegetation and site amenities.

Really creating some positive distractions and hopefully, you know, improving and providing the best space that we could for the function that needs to occur within this space.

Lastly, just want to leave you with some thoughts on continuum of kind of the emergency care.

Right?

So we've talked about the rural aspect of this and needing to transfer mostly patients out.

So typically we would see one helipad.

You'll notice there are three helipads.

That is very atypical but for good reason.

So our building in the center, we talked about that very efficient staff.

We elected to put the helipad direct on the roof.

That really is like the quickest way for them to get patients out of the facility directly from and or some other floor within the building.

But that said, there are times and it was freaking enough where they have multiple patients, they're trying to get out and they're trying to maneuver two helicopters on their existing fly public.

We ended up deciding to do a redundant pat on the South.

So there's a ground mounted helipad just on the bottom of the site there, with a path direct back to land and then lastly, unfortunately, there are instances along the highway where this hospital is situated where, I don't know, car crash or something else, unfortunately.

And EMS and the air services need air transport need to convene.

And the safest place to do that is at the hospital.

But they're not taking the patient to this hospital.

So up on the north side of the site was the existing ground at a location.

It actually sits up by the existing hospital, and it was just too far for us to use that day to day on this project, but it was the perfect solution.

We ended up leaving and kind of refurbishing that helipad to support those, you know, the community at large, if you will, and support those those situations that might arise.

So whether it's Kyle Field or a rural hospital, the lesson is still the same.

The fundamentals really matter, but it's the unique, community driven spaces that give identity, belonging and meaning to any facility.

And as designers, that's where our work becomes, less about design and more architecture, community focused.

Thank you.

So thank you for.

So that was that was an excellent case of study and directly related to what you guys are working on in the studio.

So we can take, 1 or 2 questions at a time.

Yeah.

Have room for two questions.

Students.

If you can't think of something about the project, I'm happy.

We're happy to answer, you know.

Yeah.

Questions or something about Tim Cooper.

Do you have a question for us?

Okay.

If there are no questions from the students, we will go.

Participants.

Yep.

Okay.

Oh, I think she had a cochair.

Kathy has a question.

There you go.

Yeah.

The like were you saying observation or.

Yeah.

Yeah.

So observation.

Right.

So I'll start with the observation.

Yes.

Essentially the patient might just be monitor.

They're not super critical right in that instance.

But they're going to be there generally with OBS we say less than 24 hours.

The reality is more like two days.

So they provided a patient bed for more comfort.

And absolutely, they would want to encourage families to be in there and families are likely staying and we want to have somewhere to sleep.

Those recliners are like, you know, we are able to to fill those out.

And those two things with information in ICU.

I my own personal experience with instances there, but yes, family members are definitely there.

A lot of times.

And, and we want to be there and want to be close to the staff.

So I guess just in the short answer.

Absolutely.

But I know, I know one.

Oh, okay.

We are not going to do that with, Oh, okay.

You know, I see you're sure.

Thank you, thank you.

So, That's excellent.

Presentation.

Really appreciate that.

Especially those diagrams.

Very, very straightforward and easy to understand in addition to, you know, the complicated, you know, the floor plans that, that's awesome.

And, can you explain a little bit about the, the fast track?

Because I don't I don't think a lot of people understand that fast track.

So in terms of, who's the who's using that and, why?

Yeah.

No, definitely.

So the fast track are, again, for what we would say are lower acuity patients.

Honestly, it might be I mean, I have my own personal example, presented ones where my vision was weird.

It ended up being a migraine, but I had no clue what was going on.

Right.

So you go, you don't have any acute symptoms.

Maybe they're running, like, test on you.

Maybe you're just going to go get a quick test, or some quick lab work and they but you're relatively healthy.

You know, you're not you don't need to be on a full stretcher.

And so those patients will go in there.

That's why we have the recliners.

It allows them to kind of lay them flat and do an exam.

If they need to.

The providers can come in, semi-private space.

Right.

But the reality is you're probably only there for a few hours at most.

And they want to get you back out and not taking up kind of a precious, acute care exam.

So, you know, what kind of percentage, of the patients would be going to the fast track?

Yeah.

So that is totally going to vary by facility, but I think, you know, I don't know, a general rule of thumb, we could assume maybe let's just say 20% of our 15 or 20% might be going to the fast track.

They may actually be higher here in this exact study for the reasons I had mentioned.

A lot of people are going there and treating it like their primary care because they can't get in.

I mean, we see that not even just at this facility, right?

It's like, can't get into the doctor.

Maybe I don't, you know, I'm uninsured or under-insured.

And you present at the emergency, you mentioned that some people, they are not.

You sure?

Right.

Yeah.

They're going to the GP.

They are.

They need to be receiving care.

And then, that's why some people, they don't go to the urgent care because urgent care is your insurance, right?

Yeah.

Thank you.

Fortunately, at this facility.

And we do hope that their operations change.

They are they are fully covered so the population there can go to primary care and receive that care, which is they're critically undersized right now.

So.

Okay.

Thank you so much.

Yeah.

Give it to them in the early okay.

Because you're like me I don't know.

So I can't give, a lot of specifics just because we were asked not to.

You were the client, but it's it's tribal, the population.

And so really, only, can only be used by by people, by members of the of the community.

Yeah.

Okay.

Wonderful.

You want to add something, you can go ahead.

You have time.

If you take anything away from our presentation, I think it really kind of stems from that page or terminology and acuity level of that patient is really going to dictate what area they're going to.

They're being treated by and their throughput.

Right.

What their experience is like.

So that very first encounter, when they get their intake triage to find out what's going on and really get to determine what happens for that patient and what their experience is like.

So looking to a key and I don't know, just since we're doing closing, I'll try to be brief.

Like I said, I've been doing this a number of years.

And this project, I mean, not just the Ed, the whole project, so many unique aspects to it.

And so I think.

Right, I mean, we kind of said it, but it's like our job is to we dive into the research, we're bringing them the best practices that the end of the day.

Like we have to just think creatively, like, how can we solve this unique set of challenges.

And so I did want to leave you with this is definitely not typical, which I hope that came across in here.

But gives you, I think, things that we need to be thinking about and, and considering and as designers kind of our job, I feel like I wanna say goes beyond the architecture, but we really need to understand in healthcare and the clinical operations.

Wonderful.

Excellent discussion.

Thank you so much again for joining us.