Triage: It’s Not Just for the Emergency Department Anymore

Hord Coplan Macht’s (HCM’s) team of expert led healthcare designers have partnered with healthcare organizations and care providers to determine how their facilities will be adapting to the multitude of new challenges created as a result of the pandemic.

HCM will share with you our thoughts and discussions with our valued partners who are responsible for the management of their facilities. We will focus on how the current situation, potential future and continued change will impact healthcare facility design and the creation of new environments of care. We will share the insights of our diverse team of specialists including architects, planners, interior designers, clinical practitioners and operational strategists.

The importance of accurate and efficient triage has reached new heights during the current COVID-19 pandemic. In addition to triaging patients, hospitals are now evaluating visitors, employees, and contractors – essentially anyone who steps into the facility. This new reality has moved the traditional home of triage from solely in the Emergency Department (ED) to a wider footprint.

In this installment, our team of experts discuss their thoughts on whether this trend will continue, as well as potential design strategies to accommodate the changes in methodology.

When the current pandemic is contained, will all visitors to a medical facility continue to be screened before entering?

In the aftermath of the current crisis, medical facilities will likely continue to err on the side of caution and screen all visitors. Over the long term, as this experience fades, screening of visitors may depend on where they are going within the facility. For some departments, triage may be as simple as showing proof of vaccination, for others, temperature checks and more extensive surveys might be utilized.

Our current situation has taught us to be flexible and to prepare for the possibility of new pandemics as viruses evolve. As the screening process continues to evolve and become more efficient, the capabilities of staff and spatial facility needs required to screen visitors and patients will continue to be incorporated into the arrival sequence. The use of AI technology may also allow for diagnostic evaluations and safety assessments that would enhance the triage process.

Finally, vestibules and entry areas will need to be able to quickly change to allow for necessary screening and distribution of PPE.

Will screening/triage of all patients change how we circulate or design medical facilities?

Most likely yes. This could happen in two ways.

Risk mitigation may have triage begin with a virtual process, directing EMS and patients to the most appropriate facilities and services. Spaces for this type of technology will need to be created strategically at key access points to avoid bottleneck. Additionally, pre-arrival terminals or vestibules could be created specifically for screening, or to allow visitors to enter an access code received upon successful completion of an on-line pre-screening application.

When virtual or technology-driven check in is not an option, arrival points with segregated entries between the visitor and patient populations will need to be expanded to allow for additional screening staff. These extended spaces will help maintain an efficient flow to alleviate long lines.

Will triage in the ED remain outside the footprint?

Triage outside of the ED is likely here to stay. Screening of ED patients and visitors before they access the waiting room has proven to be of benefit in both infection control and security. This ability to screen patients as early in their journey to the exam room as possible, reduces the chances of contagions spread and provides a more secure environment for patients, visitors, and staff once inside.

Will triage finally change the delivery of care in the ED?

The earlier that technology can guide patients to the right location, the better. The overall ED experience can be improved through use of tools that allow patients to wait outside until they receive an assigned turn to enter, and then direct them to the right location.

“First Look” or “Quick Look” stations are already in place in many existing ED’s. Unfortunately, these stations have traditionally been centrally located in the main lobby/waiting areas. In order to triage visitors safely, stations will need to be moved closer to the entrance to filter arrivals and direct them to their appropriate location, whether it be to the lobby, waiting areas, fast track care, or the main ED.