Security in Emergency Departments: Spatial Analysis of the Physical Environment

Abstract

Emergency departments (EDs) are one of the most complex clinical areas in the healthcare system and one of the most dangerous workplaces. Evidence shows that healthcare professionals who work in EDs are more prone to violence from patients and visitors than those working in other healthcare settings. While many studies have highlighted organizational and operational policies to minimize the risk of violence against healthcare workers, very few studies have focused on the role of facility design. This research aimed to (1) gain an understanding of environmental design features in EDs that may impact the occurrence of violet events, and (2) propose potential environmental design scenarios for future examination of ED design through primary research. Peer-reviewed and gray literature on ED design were reviewed, and case examples of ED facility design projects were identified from online sources and were spatially analyzed. Findings from the literature suggested that entry zones of EDs, including entrance doors and vestibules for walk-in patients, reception areas/desks, and waiting areas are associated with the most security issues. Based on this finding, the spatial analysis was limited to the entry zones. The design examples were categorized based on their spatial patterns and visibility properties. This typology of entry layouts helped with developing three design scenarios with different levels of visibility. The design scenarios represent the most common layouts of entry design in ED facilities. A walk-through video of each scenario is developed for future research. A future study can identify the perceived security level of each scenario by presenting them to healthcare workers and security professionals working in EDs. This research highlights the importance of interior environmental design in improving security and reducing the risk of violent behavior against healthcare workers in EDs.