Facility Space Planning for
Emergency Department
Using Simulation Analysis
SHS Conference
February 2004
Lillian Miller
Agenda
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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
Business
Planning
Real Estate
Developments
Pre- Design
Service
Programming
& Planning
Move
Management
Strategic
Facility
Planning
Facility
Management
Site
Management
Facility
Management
Services
Budget &
Estimating
Operations
Planning
Architecture &
Engineering
Services
Interior Design
Operations
Analysis
Asset Management
& Financing
Operation &
Maintenance
Program &
Construction
Management
Post
Construction
Services
Commissioning
& Start-up
Foote Hospital
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Health System
Jackson, Michigan
325 beds
Major Services:
– Behavioral Health
– Cancer Center
– Birthing Center
– Heart and Lung Services
Emergency Department
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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
Simulation
• Data Collection
• Model
Development
• Outcomes
Analysis
• Bed Needs
Triage
Nurse Sees
Pt
ED Bed
Phys Sees
Pt
Nur
se
Ambulanc
e
No
No
No
No
Order Lab?
Order Xray?
Order
Procedure?
Yes
Yes
Yes
Yes
Lab Test
Xray
Procedure
Medication
Order Med?
Stretcher
Doct
or
Tech
Wait
for
Result
Dispo
Admit
Discharge
Leave ED
Design
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Space Program
Cost Estimate
Alternative Designs
Future Design
Schedule
Facility Space Planning
Needs Assessment
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Team Development
ED Tours
Available Space
Town Meeting
Codes and Regulations
Facility Space Planning
Operations Analysis
Facility
Planning
Determine
space needs
Obtain
market study
Determine
current
capacity
Interview key
personnel
Tour facility
Assessment
Gather data
Facility Space Planning
Space Needs
• Average and
Peak Volume
• Key Rooms and
Dept Space
• Trends and
Benchmark
• Alternative
Processes
Daily Average ED Visits
190
176.5
180
170
159.9
# Pts
160
150
147.1
139.1
140
138.0
110
153.5
141.8
130130.0
120
147.7
169.5
162.5
147.2
136.0
128.4
117.5
100
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Daily Avg
Lo Month Daily
Hi Month Daily
Facility Space Planning
Layout
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Gaming Board
Initial Layouts
Beds
Support Space
Simulation
Analysis
Presentation
Results
Analysis
Problem
Identification
Scenario
Development
Model
Validation &
Verification
Process
Definition
Data Collection
& Analysis
Model
Development
Simulation
Data Collection
Projection of Patient Arrival by Hour & Year
9
8
7
Patients
6
2
5
2
2
4
3
2
1
0
0:
00
1:
00
2:
00
3:
00
4:
00
5:
00
6:
00
7:
00
8:
00
9:
00
10
:0
0
11
:0
0
12
:0
0
13
:0
0
14
:0
0
15
:0
0
16
:0
0
17
:0
0
18
:0
0
19
:0
0
20
:0
0
21
:0
0
22
:0
0
23
:0
0
• Arrival Rates
• Resource
Schedule
• Patient Types
• Activity Times
• Decision
Points
10
Hour
Simulation
Model Development
Clinic
Open
Immed
Bed
Arrive
Ambulanc
e
Hr
Of
Day
Terminal
RN Triage &
Quick Reg
NP PA
Chart
Ter
m
MD1
chart
Sched
Clinic
Acuity 1 or
2 to Bed
CDU
Acuity 2 to
Bed
Take to
Minor Trt
Rm
Acuity 4 or 5
to Bed
Acuity 3 to
Bed
RN off
duty
Stretcher
RN3 off
duty
RN
Clk Enter
Pre-Adv
Order
Pre-Advance
Orders
RN Evaluate
MD DO
Eval and
Write Order
PA NP Eval
and Write
Order
Clk Enter
Orders
Tech3
off duty
Stretcher3
Stretcher2
Tech
off duty
Tech
Clk
Complete
Reg
Addtl
Order
Clk Pull
Records
Med
Rec
Clk Call
Ancillary
Ancil
Lab
Tech Lab
X-ray
Tech X-ray
No
MD DO
Disposition
Decision
Call
Yes
Clk Call
Consult
Wait
for Call
Back
MD DO
Talk to
Consult
Repeat
Dispo Type
Clk Call for
Transfer
RN Transfer
Clk Call for
Admit
RN Give
Med IV
MD DO
3
Clerk
Wait
for
Results
Minor
Trt
Yes
Dischar
ge
MD DO
Admit
Clk3
off duty
CDU Beds
ClinicExam
Rm
CDU Leave
Clinic Leave
CDU
Decisio
n
Leave ED
PA NP
Discharge
Admit
MD DO
Transfer
Med
Merge
Ye
s
Transfer
MD3
MD3
chart1 chart2 MD DO
2
MD3
off duty
Clk off
duty
RN/Tech
Procedure
No
MD2
off duty
Clk2
off duty
Cha
rt
Proc
MD2 MD DO
chart2
MD2
chart1
PA NP
RN Admit
MD DO
Discharge
RN
Discharge
Wait to
Leave
Simulation
ED Beds Filled
40
Outcomes Analysis
ED Beds Filled
35
30
25
Maxim
35
High 9
20
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Patients in ED
Beds Filled
Length of Stay
Interim Times
Bottlenecks
Desired
Av era
40
15
3010
255
20
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
15
Hour of Day
10
5
0
Average ED Beds Filled by Type
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
40
Hour of Day
35
30
25
20
Average ED Beds Filled by Type
15
4010
35
30
25
5
0
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
Simulation
Bed Needs
• By Visit Growth
• By Process Scenario
Year 1
Year 5
Year 10
Far
Future
Routine
Process
29
32
35
39
Faster
Process
27
28
32
35
ED with
CDU &
Clinic
29
31
35
40
Scenario
Design
Space Program
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Room Types
Room Quantity
Room Area
Listing
Net Sq Ft
Building Factor
Dept Gross Sq Ft
RoomRoom
or Space
or Space
Category
Category
1 (High
1 (High
Acuity
Acuity
Level)Level)
Exam/Treatment
Exam/Treatment
RoomRoom
Trauma
Trauma
RoomRoom
Isolation/Treatment
Isolation/Treatment
RoomRoom
Isolation
Isolation
Ante Ante
RoomRoom
Cardiac
Cardiac
RoomRoom
NurseNurse
Station
Station
Pyxis Machine
Pyxis Machine
Alcove
Alcove
Patient
Patient
Toilet Toilet
Staff Toilet
Staff Toilet
Pneumatic
Pneumatic
Tube Tube
Station
Station
Alcove
Alcove
Stretcher
Stretcher
Alcove
Alcove
Equipment
Equipment
Alcove
Alcove
CrashCrash
Cart Alcove
Cart Alcove
Subtotal:
Subtotal:
Proposed
Proposed
Qty.
4
4
2
0
1
1
3
2
1
1
2
2
1
Qty.Area AreaTotal Total
Net Sq.Net
Ft. Sq.
4
4
2
0
1
1
3
2
1
1
2
2
1
230
250
230
60
250
400
25
55
55
15
25
115
15
230 920 920
2501,000 1,000
230 460 460
60 0
0
250 250 250
400 400 400
25 75
75
55 110 110
55 55
55
15 15
15
25 50
50
115 230 230
15 15
15
3,580 3,580
Design
Cost Estimate
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Renovation
New Construction
Permits and Lab Testing Fees
Furniture, Furnishings, and Equipment
Architectural/Engineering Fees
Contingencies
Escalation
Design
Alternative Designs
EXI STING
HELIP AD
EXISTING HOSPITAL
H
H
Do Nothing
Minimal Renovation
Expand Horizontal
Further Expand Horizontal
Expand Horizontal and Vertical
H
A.
B.
C.
D.
E.
EXI STING
HELIP AD
EXISTING HOSPITAL
EXI STING
HELIP AD
EXISTING HOSPITAL
EMS
ENTRY
EMS
ENTRY
SECURE
P ATI ENT
ENTRY
MAI N
LOBBY
WALK
- IN
ENTRY
SECURE
P ATI ENT
ENTRY
EMS
ENTRY
MAI N
LOBBY
MAI N
LOBBY
MAI N
LOBBY
EXI STING
CANOPY
EXI STING
CANOPY
WALK
-IN
ENTRY
WALK
-IN
ENTRY
OPTION A & B
OPTION C
OPTION D & E
Design
Future Design
Design
Schedule
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Phases I and II
Approvals
Pre-design
Schematic Drawing
Design Development
Construction Documents
Bid & Award
Construction
Project Status
and
Questions