title: Security Implications of Physical Design Attributes in the Emergency Department.
abstract: BACKGROUND
  Security, a subset of safety, is equally important in the efficient delivery of patient care. The emergency department (ED) is susceptible to violence creating concerns for the safety and security of patients, staff, and visitors and for the safe and efficient delivery of care. Although there is an implicit and growing recognition of the role of the physical environment, interventions typically have been at the microlevel.
  
  
  OBJECTIVE
  The objective of this study was to identify physical design attributes that potentially influence safety and efficiency of ED operations.
  
  
  METHODS
  An exploratory, qualitative research design was adopted to examine the efficiency and safety correlates of ED physical design attributes. The study comprised a multimeasure approach involving multidisciplinary gaming, semistructured interviews, and touring interviews of frontline staff in four EDs at three hospital systems across three states.
  
  
  RESULTS
  Five macro physical design attributes (issues that need to be addressed at the design stage and expensive to rectify once built) emerged from the data as factors substantially associated with security issues. They are design issues pertaining to (a) the entry zone, (b) traffic management, (c) patient room clustering, (d) centralization versus decentralization, and (e) provisions for special populations.
  
  
  CONCLUSIONS
  Data from this study suggest that ED security concerns are generally associated with three sources: (a) gang-related violence, (b) dissatisfied patients, and (c) behavioral health patients. Study data show that physical design has an important role in addressing the above-mentioned concerns. Implications for ED design are outlined in the article.
authors.affiliation: Department of Design, Texas Tech University, Lubbock, TX, USA d.pati@ttu.edu.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Pati
authors.affiliation: Center for Advanced Design Research & Evaluation (CADRE), Dallas, TX, USA.
authors.forename: Sipra
authors.initials: S
authors.lastname: Pati
authors.affiliation: HKS Inc., Dallas, TX, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Harvey
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005160:Facility Design and Construction; D006801:Humans; D036301:Qualitative Research; D012449:Safety; D017751:Safety Management / Q000379:methods*; D012637:Security Measures; D014754:Violence / Q000517:prevention & control
keywords: ED security; emergency departments; evidence-based design; physical design