Healthcare Design - February 2018 - 55

ANDREW LATREILLE

E X PA N D I N G C A R E O P T I O N S

Among those addressing this issue is Cincinnati Children's Hospital Medical Center in Cincinnati, which saw mental health evaluations in its EDs
almost double over the last six years, growing from 4,362 in 2011 to 8,324
in 2017. "The numbers have been steadily increasing," says Dr. Joseph Luria, who was named vice president for mental health operations at Cincinnati Children's last year after serving as the hospital's ED medical director for nine years. He attributes the growth largely to improved detection
within the community and earlier referral of at-risk patients for treatment. In 2016, the hospital added a six-bed observation unit for behavioral
health patients on its main campus to help offset some of the volume in
the ED. It also operates a behavioral health inpatient and residential program off the main campus, which can take direct admissions when beds
are available, and opened a three-story addition to the facility in 2015 that
includes a seven-bed inpatient unit and 30 residential beds.
Still, the organization is finding its efforts aren't enough to meet the
growing demand, or don't always work as planned. "One of the goals of creating [the addition] was to be able to move toward single-occupancy beds,
but when the volumes kept rising, that went by the wayside," Luria says.
"We're evaluating another expansion with the goal to go to more singleoccupancy rooms-not to increase the number of beds but really focus on
providing better patient care."
Even as it addresses space constraints, Cincinnati Children's is also adjusting its intake processes to improve flow in the ED. Benjamin Earls, associate at GBBN Architects Inc. (Cincinnati), which has worked with the
provider on the ED renovation and expansion projects, says an intake model
that places a physician in triage was designed to help segment patients by
ailment and keep less acute patients out of the ED. However, with the influx
of behavioral health patients, Cincinnati Children's has had to use the intake
area for temporary observation of those patients until they're cleared to
return to the waiting area, transferred to the observation unit, or admitted,
which has had "an adverse impact on efforts to improve ED flow," he says.
As part of a larger campus expansion that's expected to be completed in
early 2022, Cincinnati Children's is also renovating its main campus ED to

ABOVE: A ceiling feature
in the lounge area at the
Carlile Youth Concurrent
Disorders Centre provides
warm lighting, creating a
cozy glow in the evening
when other lights in
the space are dimmed.
Additionally, the use of
modular furniture gives
patients plenty of seating
options. BELOW: Patient
bedrooms feature a cozy
reading nook for quiet
activities instead of the
more typical desk. The
rooms also make use
of large windows to
maximize natural light.

support a designated behavioral health area and
care team. Flexibly designed rooms that include
ligature-resistant features and coiling metal
doors to conceal medical gases will allow clinicians to treat a variety of patient populations,
including behavioral health, and help improve
throughput. "Keeping spaces flexible will allow
for overflow during periods of influx rather than
the logjam that room designation can sometimes create," Earls says.
D E S I G N C O N S I D E R AT I O N S

A variety of inpatient and outpatient facilities
are being added to the healthcare landscape
to treat young patients with behavioral health
needs once they leave the ED. This spring,
Virginia Commonwealth University Medical
Center will open the Virginia Treatment

FEBRUARY 2018

Healthcare Design - February 2018

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