May 3, 2019

How Northwestern Memorial doubled its ED capacity without expanding. (Hint: Cubicles.)

Daily Briefing

    By installing examination cubicles in its ED, Northwestern Memorial Hospital has upped its capacity without having to undergo an expansion, Barbara Sadick reports for the Wall Street Journal.

    May 22 webconference: Curb unnecessary ED visits

    What it's like inside the cubicles

    Across the country, about 30% of EDs have added cubicles, or "pods" to provide compact examination and treatment areas for ED patients with less-acute health problems. The cubicles create more space for the hospital, freeing up areas to treat patients with more serious conditions, without the cost of a major expansion.

    Northwestern Memorial Hospital in Chicago has one of the most "advanced" sets of cubicles, according to Sadick.

    The cubicles are about half the size of a traditional ED examining room and contain reclining chairs instead of beds. Even with their smaller size, the pods have enough room for a doctor and nurse to treat and examine patients and to extend the recliner into a horizontal position. 

    The pods also include an EKG machine, oxygen, and vacuum as well as a computer monitor so that clinicians can access patients' EHR, images, and lab results.

    Other aspects, such as outlets and storage bins for personal items, "were inspired by first-class luxury airline spaces," according to Sadick.

    The cubes have three walls and a curtain for privacy. One of the walls is curved so that doctors and patients can hear each other without having to raise their voices.

    A twofold increase in capacity

    With the cubes, Northwestern has been able to double its ED capacity and bring down wait times as well as crowding.

    Jim Lennon, the designer of the pods at Northwestern Memorial, said, "It's a far more efficient use of limited real estate within the hospital." He added, "[P]atients are more accessible both physically and visually to the staff, and nurses don't have to walk as much."

    "The model works for patients who are ambulatory and don't need all the staff and equipment that would make it necessary for them to stay in a traditional [ED] bay," said Michael Schmidt, assistant professor of emergency medicine at Northwestern University's Feinberg School of Medicine. Patients in the cubicles are usually "waiting for the next step—test results, treatment, or hydration," which doesn't require a bed, Schmidt said.

    Other hospitals also have adopted pods, though they vary in design. For example, Jewish General Hospital installed cubicles that have shorter 4-foot-high walls, according to Sadick.  

    Bernard Unger, associate director of Jewish General's ED, said the cubicles help increase patient flow, but added that the lower walls make infection a bigger risk. As a result, the hospital avoids putting contagious patients in pods. The shorter pods also do little to block out noise, he said.

    However, Lennon noted that for many hospitals, adding pods, whether they come with short or higher walls, is more effective at improving patient flow than installing additional private examination rooms (Sadick, Wall Street Journal, 4/29).

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