Healthcare Design - October 2022 - 62

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in the ED an average of three times longer than traditional medical patients,
resulting in 2.2 fewer bed turnovers and a financial loss of $2,264 per patient.
A more recent study, " Economic Evaluation of the Emergency Department
After Implementation of an Emergency Psychiatric Assessment, Treatment,
and Healing Unit, " published in the journal Academic Emergency
Medicine, found that 75 to 80 percent of behavioral health patients in the ED
could have been discharged within 24 hours had they received prompt evaluation
and treatment in a calming, therapeutic environment.
Behavioral health crisis units (BHCUs) embedded within hospitals offer
such an environment. These specialized, calming spaces accommodate
the safe and efficient assessment and stabilization of behavioral health patients.
BHCUs complement the continuum of care for behavioral and mental
health patients and support the " triple aim " of healthcare: enhancing
the patient experience, improving population health, and reducing costs.
Another benefit to the BHCU model is that it provides a specialized space
that can accommodate many behavioral health patients at once and allow
for expedited and reimbursable treatment.
Approximately 100 BHCUs are currently in use in the U.S. The reason
more haven't been built is due, in part, to unfamiliarity with the facility
type and lack of planning and design standards. Hoping to clear up both
issues, the Facility Guidelines Institute (FGI) convened a topic group of
healthcare designers and behavioral health experts (including this author)
to identify best practices and establish BHCU planning and design guidance
that others could use. The topic group's work resulted in the addition
of minimum design requirements for BHCUs in the 2022 edition of FGI's
Guidelines for Design and Construction of Hospitals and Guidelines for Design
and Construction of Outpatient Facilities. Information on these standards
are also now available in a newly released FGI white paper, " Design
of Behavioral Health Crisis Units, " which offers valuable insights for both
healthcare providers and designers looking to provide hospitals and patients
with a better and more compassionate model of care.
This article discusses some key points from the white paper, including
how to best introduce a BHCU into an existing facility so it aligns with other
services and how to design and program spaces for effective treatment.
SPACE CONSIDERATIONS
The white paper offers a broad outline for planning and designing
BHCUs, beginning with location. The Guidelines documents require that
these units be placed adjacent to-or in close proximity to-a hospital's
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OCTOBER 2022
HCDMAGAZINE.COM
The milieu for a behavioral
health crisis unit
under development for
Laureate Psychiatric Clinic
and Hospital in Tulsa,
Okla., includes soft lighting,
nature murals, and
recliners to help patients
relax as they undergo
treatment and observation.
emergency department or freestanding emergency
care facility. Coupling the two departments
allows for the sharing of clinical support
services and spaces, including medical triage,
equipment and supply storage, and support areas
for staff and families.
At the core of the BHCU is a multiple-patient
observation area often called a milieu. As opposed
to individual patient rooms, which can
feel like " cells " for many people experiencing a
behavioral health crisis, the milieu gives patients
room to move about to help reduce anxiety. Patients
in the milieu typically use recliners to rest
or recuperate, and tables are available for small
group conversation. A self-serve snack or nourishment
area can give patients an additional
sense of control over their situation.
Patients also interact with clinicians in the
milieu. To encourage this connection, the white
paper authors recommend integrating nurses'
stations into this space rather than positioning
them behind a separated " fishbowl " of protective
glass, which can limit engagement and can
foster patient distrust.
BHCUs may also include single-patient observation
rooms and secure holding rooms for deescalation
in the rare instances where coercive
interventions are needed. The FGI Guidelines
documents require an intake room or area, an
exam/treatment room, and a quiet room for respite.
The total number of patient care areas will
be determined and documented in the functional
program developed by the healthcare organization
and its planning and design team.
Design in these spaces should focus on calming
the patient by including-where possible-
natural light, views of nature via windows or wall
art, and furnishings and building materials that
mitigate noise. A soothing interior design approach
with comfortable furnishings, relaxing
and muted colors , and dimmable artificial lighting
that can reinforce circadian rhythms is also
recommended.
SAFETY AND CIRCULATION
While the design and programming of BHCUs
prioritize open and calming environments,
the authors of the white paper also lay out several
suggestions for making these spaces as
safe and secure as possible. These include tactical
design and technology solutions-such as
ligature-resistant products, electronic badging
for staff, duress alarms, and surveillance cameras-as
well as organizational approaches that
include training staff on how to de-escalate
patients exhibiting aggression.
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