Challenges of the next generation hospitals: Rethinking the Emergency Department

The COVID 19 outbreak dramatically highlighted the inadequacy of the Emergency Department (ED) settings in dealing with events that can acutely affect a wide range of population. The immediate urgency to create strictly distinct pathways became also a strategic aspect for reducing possible sources of contagion inside the hospital.1 This need has often clashed with inadequate structural conditions of the hospital: in fact, the rigidity of many EDs is due to the hospital typology and its localization (affected by functional program); and it prevents them from being quickly adapted to new needs in the case of maxi-emergencies.4 In several recent international projects, the presence of a multifunctional space and/or a buffer area guarantees different scenarios in relation to the healthcare/emergency needs. Unfortunately, adding more stretchers is too often the only possible response to overcrowding. In addition, there have been calls for years now for emergency rooms to be adapted to the needs of the frailest patients, particularly the elderly, who make up more than 30% of the ED accesses and who need a suitable environment for their physical limitations (reduced walkability, sensory reductions such as sight and hearing) and cognitive limitations (dementia). There is also a frequent lack of spaces to manage the patients with acute behavioral disorders, who need a quiet environment, safe furnishing, and the possibility to be monitored, observed, and treated outside the ED’ hard area. The ED is, as its mission, a dynamic environment that must deal with the expected and the unexpected events. This implies that its organization must be flexible so that teams can always respond appropriately to the changing needs. A proper support of the architecture, its technologies, and overall facilities is essential to make this possible. Starting from these assumptions, a group of experts in emergency medicine from the AcEMC (Academy of Emergency Medicine and Care), a team of researchers in healthcare design of the Design & Health Lab (ABC Department) of Politecnico di Milano (Milan Polytechnic University) and other experts in the field gave rise to a collaboration for the definition of the emergency room 4.0. In fact, the aim was to develop a proposal for a structural and functional model of the Emergency Room and to identify the best design strategies to implement it for the new construction hospitals and for the renovation of existing facilities. This position paper aims to give rise to a Decalogue that is based on the analysis of the Scientific Literature and some useful strategies argued between experts in hospital design and practicing health professionals. It aims to become a starting point on this field of interest for the Scientific Community, with the ambition to continue the studies in the field and to be continued and detailed over time as useful reference for future evidence-based projects.