Bolstering ER security through environmental design

Experts discuss security considerations for building, renovating hospital emergency departments

In addition, York recommends that hospitals create separation within the waiting area itself to avoid potential conflicts between, for example, families or rival gang members whose relatives or friends have been brought to the facility for treatment. “When we can, we want to be able to make certain we have that ability to have some separation of the waiting area itself, especially if we have someone who is acting out,” says York  

Atlas says that hospitals should use both human and camera surveillance in their emergency departments. “All of those CPTED principles (access control, surveillance and territoriality) apply to an ER/ED by having good natural surveillance by staff of public areas and having good mechanical surveillance with cameras watching the hallways and the entry points to have the ability of playing it back later if someone steals something, someone gets hurt or a patient walks off and all of those kinds of things,” says Atlas. “You also have what I call organizational surveillance meaning you have either the receptionist or the triage nurse that interviews people as they come in and tells them how long it’s going to be and manages the flow of people.”

York says it is also a great psychological deterrent to position a camera and corresponding video monitor either inside the waiting area or in the entrance vestibule where people can see that their actions are being recorded. “It is much more effective than signs and it really helps us understand what is going on. Patients and visitors entering the facility are able to see themselves on the monitor and realize the security is taken with importance here,” he added.

Both York and Atlas believe that access control is paramount when it comes to protecting any healthcare facility.

In the emergency room itself, York says that security personnel need to have the ability to restrict access to the facility with the push of a button. “How is the flow of traffic coming in and out of the emergency treatment area? We want to have one major point of control,” York explained.

According to Atlas, there should be separate ingress and egress points for patients/visitors, as well as clear, separation of the access paths for the public and for staff members. Healthcare facilities could also consider having a third entrance just for nurses and doctors. “There also should be mechanical access, either biometric, card access or some kind of electronic access device, preferably hands-free to restrict access to private areas,” Atlas explained.

Atlas added that the third CPTED principle, territoriality, is also important from a psychological perspective to help set the “ground rules” for behavior once people arrive at the facility. This can be accomplished through good signage. “Where do you want people to go? What do you want them to do? And where should they go or not go?” says Atlas.

There are also many subtle ways that hospitals can reduce tension among patients and visitors to the emergency department.  For example, York said hospitals need to have basic necessities in place, such as restrooms, vending machines, telephones, and televisions. York says hospitals that do have televisions need to make sure that they are tuned to programming that is not going to potentially fan the flames of angst.

“Be smart with your visitor comforts. I encourage most of the clients I work with to closely manage who has control of the television,” says York. “Jerry Springer or other emotionally inciting programs are not recommended. The hospital should control the programming.”

According to Atlas, one of “prime directives” in designing an emergency room or emergency department is stress reduction.  “You want to have good acoustics so it is not loud and noisy. You want to have the ability of communicating clearly and not having to shout with the triage nurse or vice versa, especially in an ER,” says Atlas. “You want to have a clock in the waiting area , so people can watch and see how long they’ve been there and giving them information about when you are going to see them and what you’re going to do for them. Another important design directive is lighting and having lighting that is good quality but not obtrusive with glare. Color is a very important issue in ERs in that you want to use color schemes that are calming and soothing. There actually needs to be a discussion about the mood that you’re trying to present in the ER.”