Emergency care continues to experience growth and pressure to respond to new demands, including pandemic epidemics, terrorist threats, and natural disasters. Many traditional emergency service models are being modified to respond to these issues. This presentation will focus on tools to estimate demand, the exploration of organizational models, layout topologies; and the description of innovative concepts for responding to surges in demand resulting from event scenarios.

Emergency visits have continued to increase at an annual rate of 2 percent nationally since the mid 1980s. Organizational and design concepts which worked for small services are not directly transferable to larger volume EDs. This presentation will recap methods to estimate treatment space requirements; how to translate the treatment room estimate into departmental space requirements; and the implications of new operational options. Included in the presentations will be innovative models of front end processes, including replacing traditional triage with a pivot nurse concept and the implementation of rapid assessment teams to accelerate provider-patient contact during peak periods.

Simple tools, including pre-design mock-up, Sketch Up models, computer simulation, and paper simulations will be presented as approaches that can enhance user input and understanding. Examples of evidence based survey tools for assessing patient and family perceptions of facility issues will also be discussed. Recent studies into the layout efficiencies of eighteen new emergency services will be presented, along with sample layouts of treatment spaces for ten different EDs.

Alternative organizational models will be presented and discussed, including the traditional ballroom core organizational model; pod modules; and linear, internal staff work core designs. The implications on operations, exam room size and overall flexibility will be discussed, with audience comments encouraged.

The final component of the presentations will discuss issues related to event scenario planning. Example from the federally funded ER One study, and recent projects, including Tampa General Hospital, which can expand from 72 treatment stations to 210 treatment locations within the same departmental area will be presented.