Newham A&E first to test new design for reducing violence

Revamped A&E tests new theory that simple changes to the design of the environment can improve services

The newly revamped emergency unit at Newham University Hospital is the first example of using design to improve patient flow and reduce incidents of violence

A busy London A&E unit has been given a facelift in an effort to improve patient flow and reduce incidents of violence.

The new emergency department and urgent care centre at Newham University Hospital is the first in the country to embrace the recommendations outlined in the Design Council’s Reducing Violence and Aggression in A&E programme.

The Department of Health recognises that good design in the development stage of a product or service improves its chances of successfully solving problems, delivering cost-effective solutions and enhancing the patient experience

The £7.2m ProCure21 refurbishment project, delivered by contractor, Osborne, has created a unit split into distinct areas - a traditional emergency facility for patients with serious illness or injury, an urgent care centre, and a GP-led practice.

Facilities inside A&E include an expanded 18-bed majors area with dedicated cubicles for the care of patients with gynaecological and psychiatric needs; and a seven-bed resuscitation unit with paediatric and isolation services. The GP centre has five treatment rooms and there is an eight-bed urgent care centre.

There are now private cubicles with the emergency department

Key to the design of the unit was early discussions with the police in an effort to include features that would help to dampen patients’ fears and reduce the probability of violence against staff or damage to hospital property.

Based on the Design Council’s recommendations, particular attention was paid to lighting and wayfinding, with increased signage helping to explain how the department works at every stage in the patient pathway.

Speaking to BBH this week, Elizabeth Smith, business unit leader of Osborne’s healthcare team, explained: “Central to the design was the idea of the patient journey, and from the very beginning we wanted to make sure this was clearly defined.

“The design for Newham is split into two, so that as soon as patients enter they are triaged and sent either to the emergency A&E unit or to GPs, who have access to diagnostic facilities such as X-rays.

We wanted to take away the confusion, frustration and fear that often accompany a visit to A&E so that there was less potential for conflict

“From the very start we liaised with staff, patients and the police. In terms of helping to reduce violence and improve security, it was about making spaces less cramped and being more informative. In the unit we have a lot of information strips on the walls that tell people where they are and what will happen to them.

“The unit design is light and bright and people can find their way around easily. We wanted to take away the confusion, frustration and fear that often accompany a visit to A&E so that there was less potential for conflict.”

Figures show that a fifth of all violence and aggression against NHS staff happens in acute hospitals, in particular within nA&E departments. The estimated cost of this exceeds £69m a year. The aim of the Design Council’s initiative is to show how changes to the physical environment and processes can address this problem.

At the end of the day it is easier and cheaper to plan things in from the outset than to add them down the line

The document states: “The Department of Health recognises that good design in the development stage of a product or service improves its chances of successfully solving problems, delivering cost-effective solutions and enhancing the patient experience.”

From a clinical perspective, the design of Newham also aids patient throughput. Smith, a former nurse, said: “We spoke to clinical staff from the very beginning. At the end of the day it is easier and cheaper to plan things in from the outset than to add them down the line.

“From a clinical point of view, staff want to be able to treat people as quickly as possible and to assign them to the right place, with the right team, at the right time. Hospitals are anxious about waiting times, so they want to make sure treatment is happening as soon as possible. The design at Newham follows the patient journey, providing the optimal environment.”

In terms of helping to reduce violence and improve security, it was about making spaces less cramped and being more informative

The project, which opened in time for the busy Olympic period, has won a Secure By Design Award , recognising the efforts made to enhance security and improve the patient experience.

Natalie Firminger, clinical design and project manager at Barts Health NHS Trust, said: “The new emergency department and urgent care centre will allow us to provide the highest level of care we can to patients who need it the most, and its completion demonstrates our continued commitment to delivering quality care to the people of Newham and the surrounding boroughs.”

Commenting on the impact the development has made, Dr Angharad Spencer, who works in the Emergency Department, said: “Having individual private cubicles offers greater dignity and privacy, which makes it so much easier to talk to patients and their families. The design is also tailored to improve the experience for our younger patients with a bright and airy child friendly space. It is a far better environment for patients and staff alike.”

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