M.Sc . ETH SIA Hans Eggen Senior Partner, Itten + Brechbühl AG, Bern - Switzerland

1. Taking Aim at Health Care Quality through the design of Environment of Care The environment of care in emergency departments under growing requirements M.Sc. ETH SIA Hans Eggen Senior Partner, Itten + Brechbühl AG, Bern - Switzerland Health care In Switzerland Yes, everything is changing and not only for emergency departments

2. Taking Aim at Health Care Quality through the design of Environment of Care The environment of care in emergency departments under growing requirements Canada compared in size with Switzerland in the same scale

3. Healthcare system of Switzerland 450 km 220 km

4. Healthcare system of Switzerland 8 Millions of inhabitants growing older 23 % of it are foreigners University hospital Bern emergency department Large size 26 inner states 26 healthcare systems 450 km Regional Hospital Thun emergency department Medium size 220 km

5. Regional Emergency department Hospital in Thun Before construction

6. Regional Emergency department Hospital in Thun Construction completed

7. Regional Emergency department Hospital in Thun Where and how 1 5 1 2 5 Where and how can the layout be expanded? M

8. Regional Emergency department Hospital in Thun 19 emergency therapy rooms 2 for minor cases 1 2

9. Regional Emergency department Hospital in Thun: the nursing centre

10. Regional Emergency department Hospital in Thun : Planning challenge: flexible layout, more privacy, larger capacities and CT room directly linked together Shock room 1 2

11. Regional Emergency department Hospital in Thun: shock room

12. Regional Emergency department Hospital in Thun: The CT is directly adjacent to the shock room

13. Regional Emergency department Hospital in Thun and CT room and further x ray rooms Shock room staff rooms and offices

14. Regional Emergency department Hospital in Thun OP Department Minor surgery, plaster room Material room 1 1 2 P M

15. Regional Emergency department Hospital in Thun: Emergency department with OP as horizontal concept Original surgery department 1 5 1 2 5 M Ex In OP

16. Regional Emergency department Hospital in Thun 1750 m2 3600 m2 University Hospital Bern 35’000 p/y 23’000 p/year The regional Hospital in comparison with the University Emergency Department (both in the same scale) grid =

17. University Emergency departmentINO Bern Filter for minor problems as fast track All the rest for heavy cases Drive – out Drive - in

18. University emergency department Bern 100 m 100 m

19. University Emergency departmentINO Bern Given primary system and place of the cross section

20. University Emergency departmentINO Bern Cross section Emergency with OP as vertical concept more than 100 m OP Emergency Drive -in 8.4 m

21. University Emergency departmentINO Bern: check point Access way to shock rooms 8.4 m

22. University Emergency departmentINO Bern Emergency CT

23. University Emergency departmentINO Bern Lodox

24. University Emergency departmentINO Bern Therapy rooms 8.4 m depa

25. University Emergency departmentINO Bern Therapy room

26. Comparison of Emergency departmentsINO Bern

27. Comparison of Emergency departmentsINO Bern

28. University Emergency departmentINO Bern New planning tool on real basic data

29. University Emergency departmentINO Bern Actual moment in the middle of the night shock rooms and x ray 1 patients 1 doctor in the triage room 3 patients waiting 1 nurse waiting 1 patient as minor case 1 patients 2 nurses with a patient

30. University Emergency departmentINO Bern The result with this planning tool can be presented as a video Number of patients Not acceptablesituation of anticipated Flow – in of patients Still anacceptablesituation: 50 patients present in 1 minute days 7 1 2

31. University Emergency departmentINO Bern A practical study task to be explained with the planning tool: How many more persons as staff would be needed if during one year 4000 more patients would arrive all of them with an eye problem (This could actually happen if the private clinics close their eye departments) What would you guess is needed for an acceptable solution? The result is: Just 1 nurse only and even only half-time is needed. The result with this planning tool can be presented as a video in slow and fast motion

32. Taking Aim at Health Care Quality through the design of Environment of Care The environment of care in emergency departments under growing requirements summary M.Sc. ETH SIA Hans Eggen Senior Partner, Itten + Brechbühl AG, Bern - Switzerland Health care in Switzerland