CASE STUDY 01: CHILDREN & ADOLESCENTS In 2004, following a survey of 197 Australian Hospitals, the Association for the Wellbeing of Children in Healthcare (AWCH) identified Emergency Departments (ED) as an area within hospitals that needed to be made more child and youth friendly, especially in general hospitals (AWCH, 2010, p7). AWCH research indicated time spent waiting, overcrowding, and lack of supervised play contributed to negative perception of EDs on patients and families. The difference between adult and paediatric care affects how EDs manage check-in and triage for children. Paediatric EDs need to take care to properly identify the child patient and ascertain guardianship upon arrival. This is especially important in urban settings that deal with a high amount of foot traffic. This may be supported by secured vestibules and registration desks, visual transparency and security cameras (Vickery, 2011(1)). Space planning should consider how to maintain security and safety for children while being processed, in waiting rooms and play areas. Children are usually accompanied by 1 or more family members who may stay with them throughout the ED visit. Treatment areas and waiting rooms that are large enough to accommodate multiple families, while maintaining separation and privacy, help to relieve anxiety. Children and adolescents have very different social needs depending on age. Adolescents require a balance between privacy, intimacy and social interaction between people. Activi-
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ENVISION WELLNESS Acute Health Design
ties need to be suitably stimulating for older children and teenagers. Programmed spaces such as music areas and games rooms are likely to be preferred by adolescent patients to provide distraction and alleviate boredom (NACHRI, 2008, p3). In the U.S. and Canada, child life specialists have developed hospital based services to support children and families in paediatric units. They focus on providing support in stressful environments through therapeutic play, art and age-appropriate activities. This is intended to relieve anxiety about upcoming procedures and parents are encouraged to participate. Medical information, through digital, online and print resources can also be provided in a variety of languages for parents to research their child’s condition, as well as child-friendly books and magazines. All these services can be combined to provide parents and children relief from stress and boredom at the hospital (Vickery, 2011(2)). In 2003, a dedicated paediatric waiting area and treatment area was constructed in an Australian metropolitan teaching hospital with 34,000 ED presentations per year. The Center for Health Design conducted a study to explore how redesign affected patient and staff satisfaction, as well as other members of medical/nursing staff. The study found that the most striking change was in the patient-family group who showed an increased level of satisfaction with the physical environment and their overall care (Judkins, 2003).
Evidence-based design strategies that relate to paediatric health services have been outlined by the National Association of Children’s Hospitals and Related Institutions (NACHRI) in the report ‘Evidence for Innovation: Transforming children’s health through the physical environment’ (2008). A number of these strategies are relevant to the design of paediatric EDs: Improving sound absorption through ceiling tiles in all environments: This is a relatively low cost strategy designed to reduce noise levels and reverberation times. They can be incorporated into nearly any environment and an acoustic consultant can provide advice regarding placement and selection to achieve maximum effectiveness. Noise audits can provide valuable information and lead to a comprehensive noise reduction plan. Low cost solutions can be developed to deal with specific noise problems, and change management and nursing to reduce noise impacts. Providing space for families in all patient rooms and in all units: Single family rooms provide the most supportive environments, however this is generally only possible in new build or renovations. However, family spaces can be created in existing facilities to allow parents and siblings to stay close to the patient.
