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34 / BUILDING DIALOGUE / March 2020 ELEMENTS Construction Methods Transforming St. Francis Hospital's Emergency Department: Split-Flow Design Improves Patient Satisfaction, Experience I t’sno secret that Colorado’s population, and thatofElPasoCountyinparticular, isboom- ing. The U.S. Census Bureau estimated that El Paso County’s population grew by 10.6 percent between 2010 and 2016, with the population con- tinuing to grow. St. Francis Medical Center is one of two hospitals that make up Penrose-St. Francis Health Services, part of Centura Health, in Colorado Springs and serves all of El Paso County. Since 2008 the emergencydepartment, a Level III trauma center, has experienceda50%increase inpatient volumeand nowserves 47,000 patients per year. In response to this growing population and increas- ing patient volumes, SFMC undertook a major expan- sion resulting in a four-story 168,000-square-foot addi- tion that increases the number of beds in the level III NICU, provides 10 newoperating rooms, and features a brand-new, state-of-the-art trauma Level III emergency department. Through extensive research and a highly collaborative design process, the ED moved to a split- flow model of care, significantly improving staff effi- ciency and patient satisfactionwhile reducing patient wait times. This was achieved through early triage to assess the severityof illness and theparticularneedsof the patient, more accurate patient room assignments, clarified wayfinding, improved ease of patient/family communicationwith staff, and improved organization of staff stations and resource layout. All this in an ED that is as beautiful as it is efficient and functional. • Design process. The design team underwent an immersion experience in which they shadowed and observedtheoperationswithintheexistingEDfor a12- hour period that overlapped with a staff shift change. One key observation during the immersion process was the limitationof theexistingpodmodel. Thegeom- etry of the pod model compromised staff interaction and collaboration due to the limited ability of the staff toseeand interact fromone staffworkarea to thenext, inherently creating silos. In addition to immersion, a design advisory group also was formed; it consisted of key personnel includ- ing ED physicians, managers, nursing staff, the archi- tect, the engineering consultants and the general con- tractor. This DAG undertook tours of other EDs that represented various flow and organizational models, including traditional triage, split-flow, direct bedding, on-stage/off-stage, inner core and ballroom models. During these site visits, the DAG was able to speak di- rectlywith nurses and physicians to see and hear first- hand how their ED was performing. The design team then applied those lessons learned to the new design. Finally, the DAG tested the models against one anoth- er through paper simulations, mockups and scenarios runwith staff and physicians. • Themove to the split-flowcaremodel. Through the collaborative exploratory predesign process patient volumes, department statistics and patient experience Paul Reu, AIA Principal, RTA Architects Project Location: Colorado Springs EDFeatures: • Split-flowdesign • IPD tri-party agreement facilitating a highly col- laborative design process with owner, design team, general contractor and trade partners • Four intake rooms/ESI assessment • Six super track examrooms • CT and X-raywith internal resultswaiting • Linear ballroom at main ED with 27 exam rooms, one trauma roomand two resuscitation rooms • Six observation rooms (less than 24 hours) • Shell space for growth of observation and exam rooms • Four behavioral health rooms with familywaiting, patient shower/restroom in a secured area •Dedicated traumaelevators fromlower level ambu- lance baywith direct access to ED andOR levels • Local artwork • Daylighting Owner: Penrose-St. Francis Health Services and Cen- turaHealth General Contractor: GE Johnson Construction Co. Subconsultants: Emergency Department Consultants: Zilm& Associ- ates &X32Healthcare Structural Engineering: MGA Structural Engineers Mechanical, Electrical and Plumbing Engineering: The RMHGroup Civil Engineering: Kiowa Engineering Landscape Architecture: Ground Logic Soils and Testing: Kumar &Assoc. Size: Expansiongross area: 168,580 SF; EDarea: 79,045 SF Cost: $100 million (for the entire expansion includ- ing renovations, parking garage, ED, NICU, addition- al operating rooms and FF&E) Delivery Method: Integrated Project Delivery with multiparty agreement Design: September 2015-October 2016 Construction: May 2017-February 2019 Design Team: RTA Architects