Security Implications of Physical Design Attributes in the Emergency Department

TLDR

Security is critical for efficient patient care, yet emergency departments are vulnerable to violence, raising safety concerns for patients, staff, and visitors and threatening the efficient delivery of care. The study aims to identify macro‑level physical design attributes that can influence safety and operational efficiency in emergency departments. Using an exploratory qualitative design, the authors conducted multidisciplinary gaming, semi‑structured and touring interviews with frontline staff across four EDs in three states to examine how design attributes affect safety and efficiency. Five macro‑level design attributes—entry zone, traffic management, patient room clustering, centralization versus decentralization, and provisions for special populations—were found to be linked to security issues stemming from gang violence, dissatisfied patients, and behavioral health patients, underscoring the role of design in mitigating these concerns and informing ED design implications.

Abstract

Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel.The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations.An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states.Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations.Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.