Tips for surviving work projects in your ED

Jon Huddy, managing principal of FreemanWhite, a Charlotte, NC-based firm that specializes in health care facility design, offers these tips for surviving construction in your ED:

Understand what is coming tomorrow, next week, and next month.

What walls will be coming down? What type of work will be done, and what type of noise should you expect? When and where will the entrances be moved? Will signage be changed in time?

Communicate these plans to staff so they can anticipate changes and not be confused when they show up for work. Remember to inform the night shift, who often are overlooked.

Always ask how the next phase will affect your patient care spaces.

Your patient care spaces may fluctuate greatly. One week you may have 35 spaces when they open a new wing, but then it will drop down to 22 spaces when they take over another wing.

Plan for compromise, but avoid surprises.

Some compromise is necessary when the construction crews must do something that is disruptive. If tearing down a wall in your exam area is going to throw your department into chaos, you can work with the contractor to do it when you expect your census to be the lowest, maybe during the overnight shift. But it has to be done sometime, so be prepared to compromise.

"What you don’t want is a surprise," Huddy points out. "You don’t want the contractor to show up one morning when you’ve got dozens of patients and start knocking down your wall. Communication is everything."

Inform the emergency medical services (EMS) providers in your community.

EMS providers must know when your ED will change entrances and where to go. No one wants to see an ambulance driving around the campus looking for the temporary entrance to your ED. Make sure the signage is clear and updated regularly.

Avoid stopping the construction work unless absolutely necessary.

The ED manager should have the ability to stop all construction work, or a particular part of it, but should do so only as a last resort. Only call a work stoppage if you believe the construction is going to negatively affect patient care, patient safety, or staff safety. You also should be specific on what work must be stopped and for how long. For the contractor, there is a huge difference in asking that there be no jackhammer use for the next hour vs. no one working in a certain area for the rest of the day. One can result in reassigning a worker for a while, and the other can result in a dozen workers being sent home for the day.

Make sure all significant communication goes through the key contacts.

Key contacts probably will be the ED manager (or the hospital’s other designee from the facilities department) and the construction supervisor. Avoid having staff hand out instructions, such as work stoppages, to individual construction workers. Encourage staff to be friendly but emphasize that staff and physicians should not give direct orders.

Provide orientation for the construction crews.

Show them around so that they know the critical areas of your ED, such as trauma rooms and hallways with a lot of traffic. Point out entrances where ambulance crews will bring in patients and explain those areas need to be kept free of hindrances at all times and that there should never be an extension cord across the hallway.