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MCDM AG.COM | M A RCH /A PR IL 2017 | Medical Construction & Design 45 areas of a waiting room. There is criticism that traditional multi-bed triage models are noisy and do not provide the privacy nor the space for an adequate psychiatric assessment. It is suggested that ED designs include the option for a private triage room for patients with potential mental health conditions. NewYork-Presbyterian/Columbia University Medical Center, a private convertible room was designed with an adjacent patient safe toilet for this reason. The patient presenting at the ED triage is immediately sent to this area to be assessed by mental health professionals before being transferred to the sepa- rate psychiatric ED suite. At Weill Cornell Medical Center, the existing psychiatric ED suite was enlarged to accommodate this function in private rooms completely separate from the general ED suite. Safe treatment One study 1 demonstrated practitioners' inherent negative bias toward mental patients in the ED. The study suggested this bias may compromise the practitioners' ability to properly evaluate and treat these patients — possibly having adverse eff ects on patient outcome. The bias of practitioners, however, is not without warrant. Statistically, a third of all patients admitted for psychiatric care are involved in violent incidents, and the most frequent source of violence against emergency nurses is patients (97.1 percent) with psychiatric diagnoses a factor in just less than half (43 percent). For these reasons, it is important for designers to pay special attention to the integration of mental health services within the design of an ED and to ensure all designs address the safety and security concerns of practitioners working with this population. Early psychiatric assessment and stabilization is critical to the treatment of a patient with mental health instability. Following triage, chaperoned movement to a dedicated treatment area allows for a more in-depth mental health assessment to be conducted. Often high-risk mental health patients are shadowed by dedicated security personnel. Designers should provide space for these escorts to participate in the care of the patient, understanding the proximity of such an escort is dependent upon the severity of the patient condition; the escort may need direct physical contact or simply visual connectivity with the patient. Space for an escort may translate into a larger treatment room with a secure guest chair or a touch-down workstation outside of a patient room. Suites A stigma of inferiority is felt by many mental health patients presenting to the ED. In one study, mental health patients gener- ally reported feeling that they were not a priority — labeled and triaged as mental health patients fi rst, regardless of their present- ing physical complaints. For these reasons, this study group did not want a separate psychiatric ED space. Despite this, a dedi- cated suite has become the industry standard for the treatment of patients with mental health conditions presenting to high-volume EDs. It provides the at-risk population with a calm space to await treatment, admission and/or transfer. Dedicated behavioral health suites off er patients a space with reduced stimulants (e.g., noise and overcrowding) typical of an ED. At Weill Cornell, two suites were designed to allow for diff erent levels of diagnosis and disposition. The fi rst is a 12-bed dedicated psychiatric ED suite, with separate patient access, waiting, triage and treatment/holding spaces. No matter how patients arrive, either walk-in or EMS transport, they are immediately sent there from the general ED. In the suite, patients are assessed and either sent to an inpatient unit, discharged or sent to a specially designed 8-bed comprehensive psychiatric emergency program unit where they can be further diagnosed and receive treatment for up to 72 hours. Dedicated suites provide an opportunity for improved care and safety, as well as decreasing the risk of elopement. A review of patient volumes may inform whether a dedicated behavioral health suite is appropriate for an ED design. Many EDs have designed convertible suites that can be used for general medical patients and, when necessary, can be converted to a psychiatric treatment room in less than one minute. In such scenarios, equipment is fi xed and a temporary fl oor-to-ceiling wall is used to cover and lock all stored materials. Doors to these rooms should have unbreakable windows and either video surveillance to or visual adjacency with the central nursing station and/or security for continuous monitoring. For suicide prevention, the objects in the room such as door knobs, shower curtains, window treatments, ceiling and fi xtures, need to be specifi ed to prevent self-harm. Dedicated behavioral health suites allow for the creation of an internal waiting area that may reduce agitation. Features of an internal waiting area include psychiatric-safe furniture, calming design, exposure to nature/sunlight and visual distractions such as video and reading materials. Because the average length of stay for a behavioral health patient waiting inpatient admission is 3.2 times longer than non-psychiatric patients, maintaining an area for bathing within the suite is suggested. Expedited processing of mental health patients is always pre- ferred as studies indicate that patients in a psychiatric crisis have worsened outcomes with increased boarding times. Ultimately, regardless of length of stay, the dramatic rise in emergency patients with chronic psychiatric conditions increases the need for special- ized psychiatric EDs. These facilities should be designed to provide appropriate and timely care to all psychiatric patients who often are at risk for suicide and other acts of self-harm. Regan Henry, Ph.D., AIA, LEED AP, LSSGB, is a healthcare architect at E4H Environments for Health Architecture. 1 Rossberg JI, Frills S. Staff members' emotional reactions to aggressive and suicidal behavior of inpatients. Psychiatr Serv. 2003; 54:1388–94. Patient dining at this facility is in an open area with direct observation by staff at all times from the nursing station. There is also a security station which controls access to the room. Food is served from an adjacent food service pantry through a serving window in the nutrition station. This limits access to the lounge and keeps carts and non-clinical staff out of the patient areas.