Prisma Health, Oconee Memorial Hospital, Emergency Department

As part of a 23,000 SF addition and renovation project, McMillan Pazdan Smith guided Oconee Memorial Hospital Emergency Department staff through a process improvement exercise to develop a more efficient patient flow. Together, we more than doubled the size of their emergency department to accommodate much-needed care for the region — projected to care for 55,000 patients annually. The work was staged in two phases with the lobby renovation occurring first.

For many years, patients first gave their chief complaint to a non-clinical registration staff member, and were subsequently assigned an acuity score by a triage nurse. Given the large percentage of ESI 4+5 patients, it was determined that it would be more efficient for an experienced nurse to separate “vertical” patients from more emergent “horizontal” patients from the moment they presented at the front door, known as a “Nurse First” care model.

We also determined that the vertical patients should be treated in a fast-track/vertical care area and higher acuity in a separate emergent treatment area. This change would shorten the average length of stay for vertical patients and free up emergent treatment rooms for the sicker patients.

It was determined that the physical space would require a series of renovations to support this new operational model. Programming includes three care initiation rooms, eight fast track rooms with bays, internal sub-waiting for 8-10 patients, and caring / consultation space for vertical patients (three of the fast track rooms are equipped for behavioral health patients when needed). Additionally, we designed 22 emergent treatment rooms, one SANE suite, and two resuscitation rooms to match patient volumes.