A Visit to the Emergency Room
Sandy Boyette, AAHID, NCIDQ
As an interior designer, I understand that my greatest responsibility is to understand the needs of my client and address their needs in the design of their space. As a board certified health care interior designer, that responsibility includes completely anticipating client, staff, patient and family needs. After all, someone's health and well-being is in the balance. We've all been patients ourselves. and who wouldn’t have welcomed the opportunity to improve the design of the space, whether through better signage, lighting or flow through the space? I recently spent some time in a hospital emergency room as a patient. During my four hour visit, I must have redesigned the place 10 times!
The ER area had been recently renovated, yet the planning of the space did not seem to address some of the most basic issues for such specific use. A few thoughts:
- Provide a wide, welcoming reception area with plenty of room for arriving gurneys, wheelchairs and family members.
- Cross- traffic corridors should be extra-wide to allow equipment and patients to pass without bumping into each other.
- People arriving are urgently trying to get assistance, so it is important to have someone front and center to put them at ease and start the intake and diagnosis process.
- At this single triage station there are different languages spoken and different levels of care needed; there are insurance companies to deal with and a constant influx of unrelated emergencies and lack of privacy. The layout of the ER waiting room needs to address all these challenges.
- Different types and sizes of waiting areas should be considered to allow those who are ill to be separated from those who are injured; children should be in a separate area.
- Those who are ill lay down on the furniture, so seating quantity, layout and furniture selection for this area is critical.
- Since an ER is in operation 24/7, it is crucial that all finishes in the emergency wait area are durable and easily cleaned. Upholstery must be cleanable with bactericidal hypochlorite-based disinfectant (bleach solution).
- Lighting should be bright, but not glaring. Indirect lighting solutions provide a softer level of light quantity which in turn creates a quieter ambiance.
- Floor finishes must be smooth and slip-resistant; walls should be painted for maximum clean-ability and repair and wall protection is a must.
- Evaluate signage quantity, sizes and the need for multiple languages.
- Because they provide a positive distraction, televisions are still a necessary evil, but noise pollution can be controlled by turning the volume off and providing closed captions.
- Finally: provide several places where hand sanitizers will be noticed and are easily accessed.
Have you recently planned or do you work in an ER that seems to function exceptionally well? What are some of the design features that have been incorporated to make it a success?
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Is art a critical element in facility design?
By Betty Hintch, Online Editor
I had the privilege of attending the Healthcare Facilities Symposium & Expo in Chicago a few days ago. FacilityCare sponsored the Symposium Distinction Award and presented the honor to five deserving winners at a session moderated by the magazine’s editor, Emily Howard. Although all the winners were inspiring, I was especially captivated by Kathy Hathorn’s presentation. She is the CEO of American Art Resources, a company that plans and provides artwork for healthcare facilities.
An audience member asked Hathorn if she had to justify the bottom-line benefits of artwork in healthcare facilities. Surprisingly, she said that most hospital executives don’t have to be convinced of the positive role visual elements play in increasing patient satisfaction, boosting employee morale and strengthening brand awareness.
Healthcare facility design has changed dramatically over the last two decades. When top-level executives understand the important nuances that strategically placed artwork have on end-user experience, it’s apparent that the argument for good design is solid. In this economy, executives have to be vigilant about demonstrating the benefit of each expenditure. Pioneers in the industry like Hathorn have made the case. Artwork that reflects the needs of patients and the purpose of the facility can enhance end-user experience. From wayfinding to healing environments, art isn’t just nice to look at: It provides a better experience for patients, staff and visitors.
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Are you for or against hand sanitizers?
Americans love their hand sanitizers and antibacterial products. Almost three-fourths said they would be upset if those products were taken off the market, according to a poll by the American Cleaning Institute and the Personal Care Products Council. Special-interest groups advocate banning the use of antibacterial agents in personal care products. They cite the environmental impact of certain ingredients, imbalances in “good” and “bad” bacteria as a result of overuse, and dangers to children who ingest alcohol-based hand sanitizer products.
Most hospital patients and visitors appreciate the dispensers of hand sanitizers conveniently located in strategic places through the facility. But the presence of hand sanitizers for public use offers a false sense of security. The doctor or nurse delivering care may be more of a threat. After comparing data in two studies, Michael Millenson from Northwestern University, concluded "The guy who just used the toilet at Grand Central Station is ... way more likely to have clean hands than the guy walking up to your bed at the local hospital."
No matter where you stand on the use of hand sanitizers, here are a few facts to be aware of:
- Hand sanitizers don’t fight against MRSA, the Food and Drug Administration warns. MRSA is a major concern for many patients and doctors, so it’s important to understand what practices and products are effective against the bacteria. Hand sanitizers have their place, but hospital officials and the public need to be better educated on what antibacterial hand washes and rubs can and cannot do.
- Remember, hand washing is still the best defense. Research from Special Pathogens Laboratory studied the effectiveness of antibacterial hand rubs, wipes and soap. The study’s goal was to determine the effectiveness of wipes versus rubs. However, researchers concluded that hand washing with an antibacterial soap was the most effective way to remove bacteria from hands.
With the variety of views and warnings about antibacterial hand hygiene products, where do you stand?
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How do you use the IAHSS Basic Industry Guidelines?
By Tony W. York, CHPA, CPP
Chair of the IAHSS
Council on Guidelines
In 2005, the International Association for
Healthcare Security and Safety (IAHSS) identified he need for a unique body of
knowledge, produced by its members that provided guidance to healthcare security
leaders and administrators in key protection program areas. These Basic Industry
Guidelines, designed to be applicable to all healthcare facilities and
organizations around the world, provide information that support a safe and
secure environment while influencing the healthcare industry.
Today there are currently 33 basic industry guidelines in 10 categories disseminated by the Council on Guidelines via a guidelines handbook and the IAHSS webpage. A grant funded by the International Healthcare Security and Safety Foundation (IHSSF) is focused on creating an 11th category: Security Design and Renovation Guidelines for Healthcare Facilities. Currently, 13 different duidelines have been slated for creation by October 2011 ranging from the emergency department to areas with PHI to areas with radioactive material to name just a few.
So how do other industry professionals use the IAHSS Basic Industry Guidelines?
- Bryan Warren, IAHSS president-elect, and his employer Carolinas Healthcare
System in Charlotte, NC, which owns, leases or manages 29 hospitals use the
Guidelines as part of their annual security assessment process. The guidelines
serve as a measurement of performance for minimal security program requirements
throughout CHS regardless of the size, setting or trauma designation of the
facility.
- Gary Barnes, an IAHSS Canadian member from St John's, Newfoundland was faced with the challenging transition from a successful policing career in the RCMP to assuming security leadership for a large complex multi-site health system in his home province a few years ago. For Gary, the IAHSS Guidelines served as a foundation for the program he wanted to build for that health system – Eastern Health. He was able to position the guidelines for his executive team as the framework for the program. He received their support for building a program that is now highly regarded across Canada for its best practices.
So how do you use them in your facility protection program? How do you refer to them?
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What is your active shooter policy?
Lisa Pryse, CHPA, CPP
IAHSS
Vice-President/Treasurer,
Chief Campus Police/Public Safety, Eastern
Virginia Medical Center
pryselb@evms.edu
How do we (in healthcare security) respond to the active shooter situations that continue to occur in our facilities? How do we advise our respective C-suite executives on process, staffing and physical security enhancements? How do we discern the difference between overreacting and underreacting? These are all questions that we are asking ourselves and our consultants. In these times when hospitals are focusing on the “family-centered care philosophy,” it may seem almost impossible to increase security in this environment. There are various schools of thought on how to decrease the likelihood of such an event occurring in your facility.
- One viewpoint includes adding metal detection and package scanning to emergency department entrances, increasing the number of electronically controlled access doors and parking gates, increasing the number of uniformed security officers (to include armed officers, police and security), adding a photo visitor pass system, and increasing the number and type of CCTV cameras/monitors system, etc.
- Another viewpoint includes overhauling the “detection of and response to suspicious behavior” training for security staff as well as other ancillary and clinical staff. The Israeli Airport (and now Hospital Security) Behavior Detection method has gotten increased support in the recent past. One TSA blogger described the method: “Behavior analysis is based on the fear of being discovered. People who are trying to get away with something display signs of stress through involuntary physical and physiological behaviors. Whether someone’s trying to sneak through that excellent stone ground mustard they bought on vacation, a knife, or a bomb, behavior detection officers like me are trained to spot certain suspicious behaviors out of the crowd.” The Ben Gurion Airport pioneered the people-focused security approach. This method involves detecting suspicious people out of a crowd based on behavior, body language, speech, inappropriate attire for the situation, any behavior out of the norm, etc. Appropriate training on follow-up steps and reporting is essential to the success of this system. Some would call this type of detection “profiling.”
- A third
viewpoint incorporates some of each of the two previous viewpoints.
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Healthcare security is in the tough position of having to provide security at all levels in our facilities, while supporting our overall objectves of providing high qualtiy healthcare. The increase in violence in our healthcare facilities has required re-thinking our security applications. We must assess the risks and act accordingly to our ever changing environment. The issue of Active Shooters has become a real concern and requires that we assess our risks, plan and train our security force accordingly. We need to make sure that our C-Suite understands the need to prepare and train in advance for the active shooter, even though the possibility we will experience such an event is very low. We must work in collaboration with our local law enforcement partners to pre-plan and train for a response to an active shooter in a healthcare setting. The uniqueness of healthcare facilities make us even more vulnerable that other public settings. We must explore every option to include behavorial detection methods training for healthcare security staff, increased access controls and better screening and visitor controls in healthcare facilities.
Roger L. Sheets CHPA
LifeBridge Health Systems -
Baltimore, Maryland
I do agree with the concept and use of metal detection at the ED's. We use walk through metal detectors at our facilities. The problem with most if not all hospitals, is not typically the staff, whether it is Police or Public Safety officers, but the other entrances that are not monitored. I feel that staff education is one of our best assets. Training staff to observe and to call when they see things "out of the ordinary" is a good first line of information. The additional training of our Police Officers in rapid response and with tactical weapons also adds to our ability to react quickly and effectively. The use of photo visitor ID systems is being used in our Labor and Delivery floors and has been a success. We also have badge controlled parking and employee entrances. Having a State certified/sworn police department within the system has seemed to be a good deterrent so far. We are always looking for ways to improve.
Captain Kurt Henderson
WakeMed Campus Police & Public
Safety
I want to begin by wishing everybody a Happy and Safe New-Year.
My name is BK. I own a training company that over the past three years found itself providing training for the many health system organizations. We initially worked solely with military and LE agencies, but what we found is that with some adjustments techniques can be modified to meet CMS/TJC regulations, and in actuality minimize liability and increase staff and patient safety. Since then we have become the training contractor for many large hospitals in the northeast.
Training is the easiest and cheapest way to mitigate active
shooter scenarios, or any other violent incident for that matter.
Well
trained officers will be able to follow policies and react in accordance with
their use-of-force options. For example, unarmed officers must contain a
situation due to their lack of tools to engage an armed suspect; while an armed
security officer can and should address the armed suspect as soon as
possible.
We must realize that in an active shooter situations time equals lives. History taught us that most incidents end in a matter of minutes, and sometimes seconds, and waiting for the local law-enforcement tactical units is pointless.
As always, proper detection and deterrence may go a log way in minimizing risk and eliminating such threats. Metal detectors, even if not used all the time, are a deterrent. Uniformed patrol officers, and even profiling (which took on such a negative connotation here, but we all know as a tool to keep us safe!) are great deterrent tools that should be implemented.
I am originally from Israel, and still to this day am affiliated with some of the largest hospitals in Israel. Profiling assures that potential risks are dealt with before it is too late. It is not indiscriminately, it is mission-specific, and it works. So does the implementation of various "rings" of security, from the parameter (parking lots and even surrounding streets), to gates, and finally inside the institution.
If you want to know more specifically how Israel approaches active shooters incident, or how to better train and address these scenarios feel free to contact me or post a question on this forum and I will be happy to answer and address.
Stay safe!
BK Blankchtein
Masada Tactical, LLC
"I do agree that all healthcare facilities must increase their overall security profile to meet ever increasing threat levels from a multitude of sources, including 'Active Shooters.' The degree to which a facility or system may respond, may be directly tied to budget constraints. The Israeli Behavior Detection and Response Method is very good, and works regardless of what one is trying to hide. It is probably the least expensive of all methods looked at to meet this challenge. Metal detectors are good but costly including the extra manpower needed to operate the systems properly. Access Control, officer training and facility staff training remain in my opinion the strongest and best route for a facility to take if budget constraints are an issue. All facilities must take some type of action, keeping in mind their fiscal abilities, but efforts must be made toward overall improvement in their ability to protect against and/or in responce to Active Shooter situations. Facilities or systems that do nothing, run the risk of increasing their liability for being nonresponsive, especially when these type situations are actively happening in all sizes of facilities and physical locations of facilities. No facility is immune to this threat"
James Ronnie Alderman, CHPA
Old
Dominion Security Co., Inc.
"Lisa you make some very good points. As
I sit here at the SC police academy I have had a lot of time to contemplate gun
situations. Your blog makes me think of a small variation on the active shooter
concept. It involves handguns in the hospital that despite attempts by hospital
security and law enforcement to control the flow of weapons into the hospital;
others (authorized) bring guns into the hospital every day. More times than I
care to say I have heard of, or experienced a loss of control of weapons by
detention officers, local-off site LE and on site LE or security. The person
gets control of this weapon is just as dangerous as the person who brings their
own gun to our facility.
We try to incorporate a “where are all the guns” process so we
are never surprised by a gun that came into the facility legally but I feel we
fall way short. In SC every retired LE can continue to carry as long as they
qualify each year. I have no idea how many of these people are entering the
facility ready to help us shoot it out. Add that to the number of city, county,
and state officers who have business in our facility each day and you have a
large armed force. Did I forget to mention all the CWP holders who violate SC
law and come with their concealed guns? I suspect many of our own employees are
packing too.
I’m reminded of the old law enforcement adage, how many calls a
day do you go on that are gun calls—every one of them cause you bring the
gun.
The day we have an active shooter I wonder how many guns will
come out that we did not know where there."
Shawn Reilly
Greenville Hospital System