Mission Ready: Changing the Physical ED Environment

Purpose:  The Veterans Health Administration VHA Wellness Model of Health identifies 8 critical components of health that expand on traditional problem based care to identify the Veterans’ unique healthcare needs.  In an effort to provide holistic, patient-centered care (PCC) in the Emergency Department (ED), it is important to consider the physical environment in which staff performs their job, and the role the environment plays in the patient and patient’s family ED experience.  This presentation looks at the professional literature as it relates to the physical surroundings component of this wellness model.

Relevance: A literature search was performed to answer the clinical question “Do evidence-based, patient-friendly environmental surroundings (interventions) in the ED produce different or better outcomes for patients when compared to the traditional ED environment?” To address this question, the Johns Hopkins Research and Non-Research evaluation tools were used to evaluate articles retrieved from the CINAHL and Medline databases and articles identified from reference lists of reviewed articles.  Once evaluated, a table of evidence was created synthesizing results, identifying outcomes measured, and evaluating the level of evidence offered.  Out of 59 articles initially reviewed, 21 were found to have evidence related to the PICO question. Ten articles were identified as research studies, with one quasi-experimental design and nine descriptive or observational designs. Non-research studies included concept analysis, quality improvement projects, and expert opinions.  Common themes emerged in the findings, outcomes, and recommendations, which will be presented.

Importance:  It is important to identify what evidence exists in the professional literature, and to determine the combined level of evidence available to support practice changes. The findings from this literature review indicate that more research is needed to help clinicians understand the impact physical changes in the ED that encourage a healing environment can have on clinical care.