Emergencia WBDG

PG-18-9 – SPACE PLANNING CRITERIA March 1, 2022
256 – Emergency Department (ED)
CHAPTER 256: EMERGENCY DEPARTMENT (ED)

1 PURPOSE AND SCOPE ...................................................................................................................... 256-2
2 DEFINITIONS .................................................................................................................................... 256-2
3 OPERATING RATIONALE AND BASIS OF CRITERIA ........................................................................... 256-8
4 INPUT DATA STATEMENTS (IDS) .................................................................................................... 256-12
5 SPACE PLANNING CRITERIA ........................................................................................................... 256-13
6 PLANNING AND DESIGN CONSIDERATIONS .................................................................................. 256-41
7 FUNCTIONAL RELATIONSHIPS ....................................................................................................... 256-46
8 FUNCTIONAL DIAGRAMS ............................................................................................................... 256-47
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1. PURPOSE AND SCOPE

This document outlines Space Planning Criteria for Chapter 256: Emergency Department
(ED). It applies to all Emergency Medicine clinical services in all medical facilities at the
Department of Veterans Affairs (VA). Sections 4 and 5 of this document are implemented in
the Space and Equipment Planning System (SEPS) so that planners working on Emergency
Department projects, can create standardized baseline space plans.
The following VHA policy document(s), data source(s) and Industry Standards have been
reviewed, referenced, and incorporated as appropriate:
VHA Directive 1101.05(2) Emergency Medicine, September 2, 2016, amended March 7,
2017
VHA Emergency Medicine Management Tool (EMMT) System-wide Report FY15-19
American College of Emergency Physicians (ACEP), Policy Statement on Emergency
Department Planning and Resource Guidelines, April 2014
American College of Emergency Physicians (ACEP), The American Geriatrics Society (AGS),
Emergency Nurses Association (ENA) & Society for Academic Emergency Medicine (SAEM),
Geriatric Emergency Department Guidelines, January 2014
2. DEFINITIONS
Airborne Transmission: infection spread through exposure to those virus-containing
respiratory droplets comprised of smaller droplets and particles that can remain suspended
in the air over long distances (usually greater than 6 feet) and time (typically hours).
Automated Supply Dispensing Unit (ASDU): Automated supply or medication dispensing and
inventory control systems.
Class (Imaging Room): Designation of an imaging room based on the level of intervention /
acuity it is intended to support, with Class 1 being low-acuity diagnostic, Class 2 being
higher-acuity diagnostic or interventional, and Class 3 being intraoperative.
Computed Tomography (CT): A CT scan, or computed tomography scan is a medical imaging
procedure that uses computer-processed combinations of many X-ray measurements taken
from different angles to produce cross-sectional (tomographic) images (virtual "slices") of
specific areas of a scanned object, allowing the user to see inside the object.
Direct Line of Sight: A direct, unobstructed, line of sight from a clinician to a patient, which
is essential for suicide prevention.
Emergency Department (ED): An ED is a Service that provides resuscitative therapy and
stabilization in life threatening situations. It is staffed and equipped to provide initial
evaluation, treatment, and disposition for a broad spectrum of illnesses, injuries, and
psychiatric disorders, regardless of the level of severity. Care is provided in a clearly defined
area dedicated to the ED and operates 24 hours a day, 7 days a week (24/7).
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Emergency Department Integration Software (EDIS): The patient “tracking” system that is
used in VA emergency departments across the country. This interfaces with the CPRS or
CERNER electronic health record system.
Emergency Medical Services (EMS): EMS is a type of Emergency Service dedicated to
providing out-of-hospital Acute medical care and/or transport to definitive care, to patients
with illnesses and injuries which the patient, or the medical practitioner, believes
constitutes a medical emergency.
Exam / Treatment Room (E/T Rm): An ED patient room used for a variety of functions
including patient examination and various treatments or procedures; this room is sized and
equipped based on the specific clinical function it is intended to support. The following E/T
Rms are included in this document: General, Fast-Track, Airborne Infection Isolation, Mental
Health, Bariatric, GYN and Protective Environment. Additionally, Eye/ENT and Orthopedic
Treatment Rooms are also included.
Fast-Track: A patient area within the emergency department, used to limit overcrowding
and reduce patients’ waiting times. Patients with low acuity needing minimal resources are
commonly referred here, allowing these patients to move more quickly through the
department and providing separation from patients requiring a higher level of care and
longer care times.
First Look: A term utilized to identify a clinical staff member who initially observes the
patient entering the facility through the walk-in entrance, usually as part of the
triage/assessment and sorting function upon patient arrival.
Imaging Services: The medical specialty that utilizes imaging examinations with or without
ionizing radiation to affect diagnosis or guide treatment. Techniques used in the Emergency
Department include radiography, and computed tomography (CT) imaging.
Imaging Room: Designated room containing diagnostic equipment performing patient
procedures such as radiography, ultrasound, and computed tomography (CT).
Picture Archiving and Communication System (PACS): A system designed for the digital
capture, transfer, storage, and evaluation of medical images.
Resuscitation: The restoration of consciousness to a person whose respirations had
temporarily ceased.
Sally Port: A secure, controlled walk-in entry way into the mental health unit of an
emergency department. Typically, an enclosed room where no more than one door can be
opened at a time, used for searching walk-in mental health patients before they enter a
secured mental health unit within the emergency department.
Triage: The process of determining the priority of patients’ treatments by the severity of
their condition or likelihood of recovery with and without treatment.
Ultrasound: Diagnostic ultrasound, also called sonography or diagnostic medical
sonography, is an imaging method that uses high-frequency sound waves to produce
images of structures within your body.
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VA Medical Center (VAMC): A VA hospital facility that provides a diverse range of health
care services to Veterans.
Space Planning / SEPS
Accessible: A site, building, facility, or portion thereof that complies with provisions outlined
in the Architectural Barriers Act of 1968 (ABA).
Architectural Barriers Act (ABA): A set of standards developed to ensure that all buildings
financed with federal funds are designed and constructed to be fully accessible to everyone.
This law requires all construction, renovation, or leasing of sites, facilities, buildings, and
other elements, financed with federal funds, to comply with the Architectural Barriers Act
Accessibility Standards (ABAAS). The ABAAS replaces the Uniform Federal Accessibility
Standards (UFAS).
Average Length of Encounter (ALoE): Averaged length of time, in minutes, a patient spends
in an Exam / Treatment Room interacting with a provider and the clinical support team. It is
accounted from room “set-up” to “clean-up” by staff. This metric is used to determine the
number of annual patient / provider encounters that take place in an Exam / Treatment
Room which, in turn, is used to calculate the number of Exam / Treatment Rooms needed in
a facility based on projected annual workload. The ALoE is determined with VHA SME input
during a PG-18-9 clinical chapter revision / update.
Average Length of Stay (ALoS): The average number of days a patient Veteran stays in an
inpatient care unit. The ALoS is used to calculate the number of patient bedrooms for a
specialty by dividing the site’s projected workload by the ALoS.
Building Gross (BG) Factor: A Factor applied to the sum of all the Departmental Gross
Square Footage (DGSF) in a project to determine the Building Gross Square Footage. This
factor accounts for square footage used by the building envelope, structural systems,
horizontal and vertical circulation including main corridors, elevators, stairs and escalators,
shafts, and mechanical spaces. The Department of Veterans Affairs has set this factor at
1.35 and included guidance in case of variance when developing a Program for Design (PFD)
in SEPS.
Clinic Stop: Per these criteria, a clinic stop is the workload unit of measure for space
planning. Clinic Stops are codified by VSSC, when applicable, they are referenced by number
in the calculation of workload driven patient care spaces in this document.
Department Net to Gross (DNTG) Factor: A parameter, determined by the VA for each
clinical and non-clinical department PG-18-9 space planning criteria chapter, used to
convert the programmed Net Square Feet (NSF) area to the Department Gross Square Feet
(DGSF) area.
Encounter: An interaction between a patient Veteran and a VA provider or providers in an
Exam Room / Treatment Room / Consultation Room / Procedure Room, spaces where a
patient Veteran received clinical care.
Full-Time Equivalent (FTE): A staffing parameter equal to the amount of time assigned to
one full time employee. It may be composed of several part-time employees whose
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combined time commitment equals that of one full-time employee (i.e., 40 hours per
week).
Functional Area (FA): The grouping of rooms and spaces based on their function within a
clinical service or department.
Functional Area Criteria Statement (FACS): A verbalized mathematical / logical formulation
assigned to a FA incorporating answers to Input Data Statements (IDSs) to determine the
condition for providing the rooms / spaces listed in the FA in the baseline space program or
Program for Design (PFD) for a project. Certain rooms / spaces may or may not have
additional conditions.
Input Data Statement(s): A question or set of questions designed to elicit information about
the healthcare project to generate a Program for Design (PFD) based on the parameters set
forth in this set of documents. This information is processed through mathematical and
logical operations in the VA Space and Equipment Planning System (SEPS).
JSN (Joint Schedule Number): A unique five alpha-numeric code assigned to each content
item in the PG-18-5 Standard. JSNs are defined in DoD’s Military Standard 1691 and
included in SEPS Content Table.
Net Square Feet / Net Square Meters (NSF/NSM): The area of a room or space derived from
that within the interior surface of the bounding walls or boundaries.
Patient Unique: (or Unique Patient), A Veteran patient counted as a unique in each division
from which they receive care. Patient Uniques are included in the Registry for a VA Medical
Center.
Program for Design (PFD): A project specific itemized listing of the spaces, rooms, and
square foot area required for the proper operation of a specific service / department, and
the corresponding area for each. PFDs are generated by SEPS based on the PG-18-9
Standard.
PG-18-5: A Department of Veterans Affairs’ Equipment Guidelist Standard for planning,
design, and construction of VA healthcare facilities; a Program Guide (PG) that lists assigned
room contents (medical equipment, furniture, and fixtures) to each room in PG-18-9. PG-
18-5 follows PG-18-9’s chapter organization and nomenclature.
PG-18-9: A Department of Veterans Affairs’ Program Guide for the Space Planning Criteria
Standard use to develop space planning guidance for the planning, design, and construction
of VA healthcare facilities; a Program Guide (PG) that provides space planning guidance for
VA Medical Centers (VAMCs) and Community Bases Outpatient Clinics (CBOCs). PG-18-9 is
organized by chapters, as of September 2021 there are 56 clinical and non-clinical PG-18-9
chapters; they are implemented and deployed in SEPS so that space planners working on VA
healthcare projects can develop baseline space programs.
PG-18-12: A Department of Veterans Affairs’ Design Guide Standard for planning, design
and construction of VA healthcare facilities, a Program Guide (PG) that provides design
guidance for VA Medical Centers (VAMCs) and Community Bases Outpatient Clinics (CBOCs).
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The narrative section details functional requirements and the Room Template section
details the planning and design of key rooms in PG-18-9. Not all PG-18-9 chapters have a
corresponding PG-18-12 Design Guide; one Design Guide can cover more than one PG-18-9
chapter.
Provider: An individual who examines, diagnoses, treats, prescribes medication, and
manages the care of patients within his or her scope of practice as established by the
governing body of a healthcare organization.
Room Area: The square footage required for a clinical or non-clinical function to take place
in a room / space. It takes into account the floor area required by equipment (medical and
non-medical), furniture, circulation, and appropriate function / code-mandated clearances.
Room area is measured in Net Square Feet (NSF).
Room Code (RC): A unique five alpha-numeric code assigned to each room in the PG-18-9
Standard. Room Codes in PG-18-9 are unique to VA and are the basis for SEPS’s Space Table
for VA projects.
Room Criteria Statement (RCS): A mathematical / logical formulation assigned to each room
/ space included in PG-18-9 incorporating answers to Input Data Statements (IDSs) to
determine the provision of the room / space in the baseline space program or Program for
Design (PFD) for a project.
Room Efficiency Factor: A factor that provides flexibility in the utilization of a room to
account for patient delays, scheduling conflicts, and equipment maintenance. Common
factors are in the 75% to 85% range. A room with 80% room efficiency provides a buffer to
assume that this room would be available 20% of the time beyond the planned operational
practices for this room. This factor may be adjusted based on the actual and/or anticipated
operations and processes of the room/department at a particular facility.
SEPS: Acronym for Space and Equipment Planning System which produces equipment lists
and Program for Design for a healthcare project based on specific information entered in
response to Input Data Questions.
SEPS Importer: A style-based format developed to allow upload of RCSs and IDSs to SEPS to
implement and operationalize space planning criteria in PG-18-9 in the SEPS digital tool.
This format establishes the syntax used in the RCSs and allows the use of Shortcuts.
Shortcuts allow developers of space planning criteria statements to simplify RCSs making
full use of their logical and mathematical functionality. A shortcut can refer to an RCS, a
room in any FA or a formula. Shortcuts are [bracketed] when used in FAs and RCSs and are
listed along with their equivalences at the end of the Space Planning Criteria section.
Space Planning Concept Matrix (SPCM): A working document developed during the chapter
update process. It lists all the rooms organized by Functional Area and establishes ratios
between the directly and the indirectly workload driven rooms for the planning range
defined in this document. The matrix is organized in ascending workload values in ranges
reflecting existing facilities and potential future increase. Section 5 of this document Space
Planning Criteria reflects the values in the SPCM.
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Stop Code: A measure of workload including clinic stops forecasted by the Office of Policy
and Planning (OPP) for all Strategic Planning Categories at Medical Center and Outpatient
Clinic levels.
Telehealth: The use of technology, such as computers and mobile devices, to manage
healthcare remotely. It includes a variety of health care services, including but not limited to
online support groups, online health information and self-management tools, email and
online communication with health care providers, remote monitoring of vital signs, video,
or online doctor visits. Depending on the concept of operations for this space, it may be
equipped as an exam room or as a consult room with video/camera capability.
Utilization Rate: A factor used in the calculation of a directly workload-driven room
throughput. It represents, in a percent value, the room is idle based on the planning
assumptions. For example, if a directly workload-driven room is available for use 8 hours a
day, the Utilization Rate represents the assumed time it will be used, an 85% utilization rate
indicates, for planning purposes, the room will be used 6.8 hours a day. An additional
directly workload-driven room will be provided in the calculation once the previous room
has reached 100% utilization. The utilization Rate is embedded in the Room Throughput
value calculated in Section 3 of this document.
VA Room Family (VA RF): An organizational system of rooms / spaces grouped by function, a
‘Room Family’. There are two “Orders” in the VA RF: Patient Care and Patient Care Support;
Patient Care features four sub-orders: Clinical, Inpatient, Outpatient and Residential Clinical.
There are also four sub-orders in the Patient Care Support order: Building Support, Clinical
Support, Staff Support and Veteran Support. Each room in a Family has a unique Room Code
and NSF assigned based on its Room Contents and function which correspond to the specific
use of the room. The same RC can be assigned to different Room Names with the same
function in this document and can be assigned an NSF that varies based on the PG-18-5
Room Contents assigned to the room.
VA Technical Information Library (TIL): A resource website maintained by the Facilities
Standards Service (FSS) Office of Construction and Facilities Management (CFM) containing
a broad range of technical publications related to the planning, design, leasing, and
construction of VA facilities. VA-TIL can be accessed at: https://www.cfm.va.gov/TIL/
Workload: Workload is the anticipated number of procedures, clinic stops, clinic encounters
etc. that is processed through a department/service area. The total workload applied to
departmental operational assumptions will determine overall room requirements by
modality.
Workstation: Area outfitted with equipment and furnishings, typically allocated 56 NSF
each. Managers and other staff with no direct reports as well as part-time, seasonal, and
job-sharing staff may qualify for a workstation. Such environments are particularly
conducive to team-oriented office groupings. These environments work best when they
have access to conference and small group meeting spaces.
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3. OPERATING RATIONALE AND BASIS OF CRITERIA

A. Space Planning parameters and metrics in this document are based on the ED Space
Planning Criteria Matrix (SPCM) developed with participation of VA ED SMEs, VA CFM
personnel and Consultants during the space planning and design standards update
process. The ED SPCM lists all the spaces a VA ED site would require based on its
projected workload for 48 Exam / Treatment Room ranges.
B. Room quantity and area (NSF) for every room in each of the 48 E/T Rm ranges is
determined in the ED SPCM. These values are reflected in the Room Criteria Statements
(placed immediately below each room name, room code and NSF/NSM) for each room
in Section 5 of this document. Each range represents an annual ED E/T Rm throughput
of 1,051 patients; space planning criteria herein developed cover a projected workload
of between 840 and 50,448 annual ED encounters. The 48 ranges are subdivided in four
Modules of 12 E/T Rms each.
C. VSSC’s EMMT EDIS FY15-19 Report for 111 High, Medium and Low Complexity sites was
used to develop the ranges covering the workload demand of the existing VA ED sites as
well as for potential future larger facilities.
D. Annual ED E/T Room Throughput has been determined based on the following
parameters:
1. Target VA Emergency Department Average Length of Encounter (ALoE) = 200 mins.
2. Number of operating days / year: 365
3. High demand daily hours of operation: 12 (720 mins.)
4. Resulting annual E/T Room throughput (at 100%): 1,314 encounters
5. Adopted annual E/T Room throughput (at 80% Utilization Rate): 1,051 encounters
E. The ED SPCM range values are available to planners in the Space and Equipment
Planning System (SEPS) software hosted at MAX.gov. Sections 4 and 5 of this Program
Guide are implemented in SEPS. Space planners working on VA ED projects can generate
a Program for Design (PFD) by entering the projected Stop Code 130 workload for the
target year for the VA Station they are working on. The PFD generated by SEPS reflects
the values in the SPCM and becomes the baseline space program to begin the project
planning process.
For example:
A SC130 projection of 6,800 annual encounters corresponds to seven E/T Rooms; eight
E/T Rooms will be generated.
A SC130 projection of 24,175 annual encounters will generate twenty-four E/T Rooms.
F. SEPS incorporates a Net‐to‐Department Gross factor (NTDG) factor of 1.65 and a
Building Gross factor of 1.35 in the space calculation to generate the Department Gross
Square Feet (DGSF) and the Building Gross Square Feet (BGSF) respectively for the
project based on the aggregate resulting Net Square Feet (NSF) for each range. Planners
can adjust the BG factor in SEPS; the DG factor is not changeable.
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G. SEPS also generates the Project Room Contents (PRC) for each room in the project. The
PRC includes the equipment, furniture and fixtures assigned to each room per VA256 ED
PG-18-5: Equipment Guidelist.
H. PG-18-12: Design Guide contains a Narrative, detailed functional diagrams, and detailed
room templates for sixteen unique ED rooms.
I. The space planning and design Program Guides: PG-18-5, PG-18-9 and PG-18-12 are
available at the Department of Veterans Affairs Office of Construction and Facilities
Management (CFM) Technical Information Library (TIL) website.
J. Assignment of the resulting workload generated E/T Rms for a project is done by range
based on Tables 1 and 2 below.
A. Cols (1) and (2): Workload values for each range.
B. Col (3): Module generated
C. Col (4): Number of workload driven ED E/T Rms generated.
D. Col (5): E/T Rm type:
GEN: General
FSTK: Fast Track
AII: Airborne Infection Isolation
MH: Mental Health
GYN: Gynecology
PE: Protective Environment
E. Col (6)-(13): Assignment of each E/T Rm type per range, highlighted value indicates
value change in columns.
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TABLE 1: ALLOCATION OF ED EXAM / TREATMENT ROOMS – RANGES 1 -24
Projected Projected ED
Workload Workload ED E/T
SC130 SC130 E/T Rms Rm
From To Module Generated Type GEN FSTK AII MH BAR GYN PE
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
840 1,051 A 1 GEN 1 0 0 0 0 0 0
1,052 2,102 A 2 FSTK 1 1 0 0 0 0 0
2,103 3,153 A 3 AII 1 1 1 0 0 0 0
3,154 4,204 A 4 AII 1 1 2 0 0 0 0
4,205 5,255 A 5 MH 1 1 2 1 0 0 0
5,256 6,306 A 6 MH 1 1 2 2 0 0 0
6,307 7,357 A 7 BAR 1 1 2 2 1 0 0
7,358 8,408 A 8 GYN 1 1 2 2 1 1 0
8,409 9,459 A 9 PE 1 1 2 2 1 1 1
9,460 10,510 A 10 GEN 2 1 2 2 1 1 1
10,511 11,561 A 11 FSTK 2 2 2 2 1 1 1
11,562 12,612 A 12 GEN 3 2 2 2 1 1 1
12,613 13,663 B 13 GEN 4 2 2 2 1 1 1
13,664 14,714 B 14 FSTK 4 3 2 2 1 1 1
14,715 15,765 B 15 AII 4 3 3 2 1 1 1
15,766 16,816 B 16 AII 4 3 4 2 1 1 1
16,817 17,867 B 17 MH 4 3 4 3 1 1 1
17,868 18,918 B 18 MH 4 3 4 4 1 1 1
18,919 19,969 B 19 BAR 4 3 4 4 2 1 1
19,970 21,020 B 20 GYN 4 3 4 4 2 2 1
21,021 22,071 B 21 GEN 5 3 4 4 2 2 1
22,072 23,122 B 22 GEN 6 3 4 4 2 2 1
23,123 24,173 B 23 FSTK 6 4 4 4 2 2 1
24,174 25,224 B 24 GEN 7 4 4 4 2 2 1
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TABLE 2: ALLOCATION OF ED EXAM / TREATMENT ROOMS – RANGES 25 -48
Projected Projected ED
Workload Workload ED E/T
SC130 SC130 E/T Rms Rm
From To Module Generated Type GEN FSTK AII MH BAR GYN PE
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
25,225 26,275 C 25 GEN 8 4 4 4 2 2 1
26,276 27,326 C 26 FSTK 8 5 4 4 2 2 1
27,327 28,377 C 27 AII 8 5 5 4 2 2 1
28,378 29,428 C 28 AII 8 5 6 4 2 2 1
29,429 30,479 C 29 MH 8 5 6 5 2 2 1
30,480 31,530 C 30 MH 8 5 6 6 2 2 1
31,531 32,581 C 31 BAR 8 5 6 6 3 2 1
32,582 33,632 C 32 GYN 8 5 6 6 3 3 1
33,633 34,683 C 33 PE 8 5 6 6 3 3 2
34,684 35,734 C 34 GEN 9 5 6 6 3 3 2
35,735 36,785 C 35 FSTK 9 6 6 6 3 3 2
36,786 37,836 C 36 GEN 10 6 6 6 3 3 2
37,837 38,887 D 37 GEN 11 6 6 6 3 3 2
38,888 39,938 D 38 FSTK 11 7 6 6 3 3 2
39,939 40,989 D 39 AII 11 7 7 6 3 3 2
40,990 42,040 D 40 AII 11 7 8 6 3 3 2
42,041 43,091 D 41 MH 11 7 8 7 3 3 2
43,092 44,142 D 42 MH 11 7 8 8 3 3 2
44,143 45,193 D 43 BAR 11 7 8 8 4 3 2
45,194 46,244 D 44 GYN 11 7 8 8 4 4 2
46,245 47,295 D 45 GEN 12 7 8 8 4 4 2
47,296 48,346 D 46 GEN 13 7 8 8 4 4 2
48,347 49,397 D 47 FSTK 13 8 8 8 4 4 2
49,398 50,448 D 48 GEN 14 8 8 8 4 4 2
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CHART 1: FUNCTIONAL AREA AGGREGATE NSF BY RANGE
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47
Reception / Public Area Security / Police Area Patient Assessment Area

Patient Area Staff Work Area Emergency Imaging Area
Ambulance / EMS Area Support Area Staff and Administrative Area
Education Area
4. INPUT DATA STATEMENTS (IDS)

Text in brackets below each Input Data Statement correspond to the SEPS Importer
shortcuts.
A. How many Emergency Department (ED) annual Clinic Stops (Stop Code 130) are
projected for this facility? (W) (Values: 840 to 50,448) (Default:840)
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5. SPACE PLANNING CRITERIA

A. FA 1: EXAM / TREATMENT ROOM CALCULATION
1. Number of ED Exam / Treatment Rooms, Clncl Sprt (SC107) .............. 0 NSF (0 NSM)
a. Provide one if [Annual Emergency Department (ED) Clinic Stops (Stop Code 130)
projected] is between 840 and 1,051
b. Provide an additional one for every portion of 1,051 [Annual Emergency
Department (ED) Clinic Stops (Stop Code 130) projected] greater than 1,051 if
[Annual Emergency Department (ED) Clinic Stops (Stop Code 130) projected] is
between 1,051 and 50,448 (Maximum 48)
B. FA 2: RECEPTION / PUBLIC AREA
1. ED Walk-in Vestibule, Bldg Sprt (SB291) ...................................... 100 NSF (9.3 NSM)
a. Provide one if [ED Exam / Treatment Rooms] is between 1 and 48
2. ED Security Vestibule, Bldg Sprt (SB295)........................................80 NSF (7.5 NSM)
This space is dedicated to Security Screening.
3. ED Metal Detector Station, Police Svc (SB853) ........................... 160 NSF (14.9 NSM)
b. Provide one at 240 NSF if [ED Exam / Treatment Rooms] is between 29 and 48
Allocated NSF accommodates Security Scanner, Walk-thru Metal Detector, and
circulation.
4. ED Private Search Room, Police Svc (SB854) .............................. 120 NSF (11.2 NSM)
c. Provide one at 160 NSF if [ED Exam / Treatment Rooms] is between 25 and 48
Locate directly accessible from Security Vestibule and Metal Detector Station.
5. ED General Waiting, Bldg Sprt (SB003) ...................................... 215 NSF (20.0 NSM)
d. Provide one at 720 NSF if [ED Exam / Treatment Rooms] is between 13 and 16
e. Provide one at 935 NSF if [ED Exam / Treatment Rooms] is between 17 and 20
f. Provide one at 1,150 NSF if [ED Exam / Treatment Rooms] is between 21 and 24
g. Provide one at 1,295 NSF if [ED Exam / Treatment Rooms] is between 25 and 28
h. Provide one at 1,440 NSF if [ED Exam / Treatment Rooms] is between 29 and 32
i. Provide one at 1,725 NSF if [ED Exam / Treatment Rooms] is between 33 and 36
j. Provide one at 1,870 NSF if [ED Exam / Treatment Rooms] is between 37 and 40
k. Provide one at 2,085 NSF if [ED Exam / Treatment Rooms] is between 41 and 44
l. Provide one at 2,300 NSF if [ED Exam / Treatment Rooms] is between 45 and 48
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This space shall have direct access to outside windows for daylight. It shall have a
direct line of sight from the Reception / First Look Nurse desk. Allocated NSF
accommodates Standard Chairs, Bariatric Chairs, Accessible Spaces, and internal
circulation per Table below.
TABLE 3: GENERAL WAITING SPACE ALLOCATION
Bariatric Accessible
E/T Rooms NSF Stdrd Chair Chair Space(s) Total People
1 to 4 215 8 1 1 10
5 to 8 415 16 2 2 20
9 to 12 575 24 3 3 30
13 to 16 720 32 4 4 40
17 to 20 935 40 5 5 50
21 to 24 1,150 48 6 6 60
25 to 28 1,295 56 7 7 70
29 to 32 1,440 64 8 8 80
33 to 36 1,725 72 9 9 90
37 to 40 1,870 80 10 10 100
41 to 44 2,085 88 11 11 110
45 to 48 2,300 96 12 12 120
6. ED Family Waiting, Bldg Sprt (SB051) ........................................ 125 NSF (11.7 NSM)
Minimum allocated NSF accommodates one lounge chair @ 12 NSF, one 2-seat sofa
at 32 NSF, one accessible space @ 10 NSF, and circulation; total four people.
Allocated 200 NSF accommodates one lounge chair @ 12 NSF, one 2-seat sofa @ 32
NSF, one 3-seat sofa @ 40 NSF, one accessible space @ 10 NSF, and circulation; total
seven people.
7. ED Information Kiosk, Bldg Sprt (SB113) ........................................40 NSF (3.8 NSM)
b. Provide two if [ED Exam / Treatment Rooms] is between 25 and 48
Facility and medical information resource for patients and visitors. Locate accessible
from General and Family Waiting.
8. ED Reception, Clncl Sprt (SC183) ...................................................85 NSF (7.9 NSM)
Minimum allocated space accommodates one Reception personnel position; 260
NSF accommodates two positions.
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9. ED First Look Patient Waiting, Bldg Sprt (SB003).......................... 100 NSF (9.3 NSM)
Minimum allocated space accommodates two standard chairs @ 9 NSF each, one
bariatric chair @ 14 NSF, one accessible space @ 10 NSF, and circulation; total four
people; 170 NSF accommodates six standard chairs @ 9 NSF each, one bariatric chair
@ 14 NSF, one accessible space @ 10 NSF, and circulation; total eight people.
10. First Look Station, ED (CED11) .......................................................60 NSF (5.6 NSM)
This Station shall be located near / adjacent to the Reception. The First Look nurse
will be stationed at an open desk that observes the walk-in entrance and the Waiting
Room. This nurse will complete a rapid visual assessment of every arriving patient
and make the key decision if the patient needs to be rushed into the ED for life-
saving interventions. If not in need of life-saving interventions, the First Look nurse
will direct the patient to the appropriate location for further assessment (triage) or
treatment (direct bedding) based on the preferred flow of the ED
11. ED Copy / Supply Alcove, Stff Sprt (SS268).....................................40 NSF (3.8 NSM)
12. ED Volunteer Welcome Station, Clncl Sprt (SC005) ........................80 NSF (7.5 NSM)
13. ED Patient Discharge Room, Clncl Sprt (SC001) ............................ 100 NSF (9.3 NSM)
c. Provide three if [ED Exam / Treatment Rooms] is between 25 and 36
d. Provide four if [ED Exam / Treatment Rooms] is between 37 and 48
Quiet, private area for patients to relax while waiting for their transportation after
being discharged from the ED. Allocated NSF accommodates two lounge chairs /
recliners at 30 NSF each.
14. ED Quiet / Consult Room, Clncl Sprt (SC271).............................. 125 NSF (11.7 NSM)
This space accommodates private interviews with patients and family; furnished to
accommodate 1:1 Interviews and consultations for scheduled patients; locate near
General Patient Waiting.
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15. ED Female Visitor Toilet, Bldg Sprt (SB202)....................................60 NSF (5.6 NSM)
Allocated NSF accommodates one accessible toilet @ 25 NSF, one wall-hung lavatory
@ 12 NSF, ABA clearances, and circulation.
16. ED Male Visitor Toilet, Bldg Sprt (SB203) .......................................60 NSF (5.6 NSM)
17. ED Vending Alcove, VC Svc (SV692) ...............................................40 NSF (3.8 NSM)
18. ED Water Fountain Alcove, Bldg Sprt (SB122) ................................20 NSF (1.9 NSM)
Baseline requirement, please verify and comply with Plumbing Code as applicable.
19. ED Wheelchair / Stretcher / Lift Parking, Bldg Sprt (SB258) .......... 100 NSF (9.3 NSM)
This space allows temporary holding of beds, stretchers, gurneys, reclining chairs,
wheelchairs for patients who arrive at the ED with these transport devices or need
them to be transported to another area within the VAMC.
C. FA 3: SECURITY / POLICE AREA

1. ED Security Station, Police Svc (SB851) ........................................ 100 NSF (9.3 NSM)
This station is intended as a satellite location to the Police primary Operations
Center. Ideally, the Security Station would have direct visible control of both the
walk-in and EMS entrances, if both cannot be achieved, then priority is to have
control of the walk-in entrance. Refer to Emergency Department PG-18-12 Design
Guide Section 4 for room template.
2. ED Security Room, Police Svc (SB811) ........................................ 140 NSF (13.1 NSM)
This station or room is intended as a satellite location to the police primary
operations center. The decision to go with a partially open Security Station or a
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glass-enclosed Security Room is up to the discretion of an individual VAMC to

determine based on their requirements. Coordinate with VA Physical Security and
Resiliency Design Manual, section 5.5.4 Emergency Department, Security. When an
open Security Station is used then the designer needs to implement other design
features to provide controls to safeguard operating elements within the Security
Station. This space should always have two ways to enter/exit, with one preferably
directly to the exterior. Ideally, the Security Station/Room would have direct visible
control of both the walk-in and EMS entrances. But if both cannot be achieved, then
priority is to have control of the walk-in entrance.
3. ED Secure Evidence Room, Police Svc (SB821) ...............................80 NSF (7.5 NSM)
D. FA 4: PATIENT ASSESSMENT AREA

1. MH Sally Port, ED (CED06) ........................................................... 100 NSF (9.3 NSM)
This space is for Mental Health patients and provided when three MH E/T Rms or
greater are generated (Refer to Tables 1 & 2)
2. ED MH Private Search Room, Police Svc (SB854) ........................ 160 NSF (14.9 NSM)
This space is for Mental Health patients and provided when three MH E/T Rms or
greater are generated (Refer to Tables 1 & 2)
3. ED Patient Belongings Room, Lgstcs Svc (SB711)............................80 NSF (7.5 NSM)
Typically, patient’s personal belongings will remain in the Exam / Treatment room,
where a patient is receiving treatment. However, at times a Veteran will come to the
ED that may be homeless, or just carrying extra belongings and these items must be
stored in a separate area. This room shall include lockers to secure each patient’s
belongings, with a removable key that is kept with the patient until they are ready to
leave and pick up their belongings again.
4. ED Patient Height / Weight Alcove, Clncl Sprt (SC067) ...................40 NSF (3.8 NSM)
5. Triage Room, ED (CED12) .......................................................... 150 NSF (14.0 NSM)
The Triage Room shall be designed with direct access and visual observation of the
ED Waiting Room. If possible, the Security Station should have visibility through the
glass-front Triage Room to observe first interaction between nurse and patient. The
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room is also designed to have flow-through patient movement, so they enter

directly from the Waiting Room and exit directly into the clinical area of the ED.
Refer to Emergency Department PG-18-12 Design Guide Section 4 for room
template.
6. Bariatric Triage Room, ED (CED13) ............................................ 180 NSF (16.8 NSM)
The Bariatric Triage Room has the same purpose, and design, as the Triage Room,
except it is to be larger in size to accommodate bariatric patients, patients on
motorized wheelchairs, or a larger family group, as needed. Refer to Emergency
Department PG-18-12 Design Guide Section 4 for room template.
7. ED Triage Patient Universal Toilet / Shower, Bldg Sprt (SB199) ......85 NSF (7.9 NSM)
Allocated NSF accommodates one accessible toilet @ 25 NSF, one accessible wall-
hung lavatory @ 13 NSF, one accessible shower @ 28 NSF, ABA clearances, and
circulation.
8. ED Triage Staff Workstation, Stff Sprt (SS215) ...............................50 NSF (4.7 NSM)
9. ED PPE Alcove, SPS (SC856) ...........................................................20 NSF (1.9 NSM)
This alcove is provided to dispense and don protective clothing prior to entering the
Patient Area.
10. ED Medical Supplies Alcove, Clncl Sprt (SC282) ..............................30 NSF (2.8 NSM)
11. ED Clean Utility Alcove, Lgstcs Svc (SB735) ....................................15 NSF (1.4 NSM)
This area provides storage for sterile and non-sterile medical supplies.
12. ED Soiled Utility Alcove, Lgstcs Svc (SB741) ...................................20 NSF (1.9 NSM)
This room is used for disposal of waste material as well as temporary holding of
items to be returned to SPS.
E. FA 5: PATIENT AREA
1. ED Results Pending Accessible Waiting, Bldg Sprt (SB071) ........... 105 NSF (9.8 NSM)
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A small internal waiting room for “vertical” patients that had tests completed and
are comfortable awaiting test results in a chair or recliner. This space should be near
a Consultation Room so results and discharge instructions can be delivered in a
confidential environment. Allocated space accommodates one standard chair @ 9
NSF, one bariatric chair @ 14 NSF, two accessible spaces @ 10 NSF each, and
circulation; total four people.
2. Fast Track Exam / Treatment Room, ED (CED22)........................ 160 NSF (14.9 NSM)
e. Provide five if [ED Exam / Treatment Rooms] is between 26 and 34
f. Provide six if [ED Exam / Treatment Rooms] is between 35 and 37
g. Provide seven if [ED Exam / Treatment Rooms] is between 38 and 46
h. Provide eight if [ED Exam / Treatment Rooms] is between 47 and 48
The fast-track system at the emergency department is similar to urgent care.
Patients who are triaged (or sorted) into the fast-track system typically come in with
lower acuity complaints like a sore throat, a rash, urinary tract infections, and minor
injuries. Most of the time, patients that go to fast-track are generally healthy, and
their complaints can be diagnosed through a history, physical, and x-ray or point of
care test (such as a urine dip). For maximum flexibility, this room is designed exactly
like the General Exam/Treatment room, except it is equipped with a reclining type of
exam chair rather than a stretcher. Depending on surge demands within the ED, or
time of day, this room can then be utilized as a General E/T Room also. The Fast-
Track E/T Room should be located near the patient assessment area. Refer to
Emergency Department PG-18-12 Design Guide Section 4 for room template.
3. Fast Track PPE / O.R. Equipment Alcove, ED (CED41) ...................... 5 NSF (0.5 NSM)
Patient Area, locate this room adjacent to the Fast Track E/T Rm. Refer to
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4. ED Consult Room, Clncl Sprt (SC271) ......................................... 120 NSF (11.2 NSM)
This space provides for a private area for Physicians or Nurse Practitioner to explain
a procedure, obtain informed consent, explain discharge instructions, and follow-up
with the patient, or patient’s family. The Consult Room(s) should be adjacent to the
Results Pending Waiting where multiple patients may be awaiting testing results,
thus offering a location for private discussions with the clinical teams.
5. ED Women’s Health Consult Room, Clncl Sprt (SC273) ............... 120 NSF (11.2 NSM)
This space accommodates private interviews with patients and family; furnished to
accommodate Means Testing; locate near Reception.
6. ED Women’s Health Storage Room, Wm Vet Svc (CWV91) .............80 NSF (7.5 NSM)
7. Point -of-Care (POC) Testing Alcove, ED (CED33)............................50 NSF (4.7 NSM)
Point-of-Care Testing (POC) enables more rapid clinical decision-making in the
process of diagnosis, treatment choice and monitoring, and prognosis, as well as
operational decision making and resource utilization. Possible tests that can be
performed at the POC Testing alcove include NTpro-BNP/BNP, Troponin, D-Dimer,
Glucose, Ketones, Pregnancy, Creatinine, Lactate, Influenza, HIV, Blood gas, and
electrolytes. Refer to Emergency Department PG-18-12 Design Guide Section 4 for
room template.
8. ED Patient Toilet, Bldg Sprt (SB201)...............................................60 NSF (5.6 NSM)
a. Provide two if [ED Exam / Treatment Rooms] is between 1 and 12
b. Provide four if [ED Exam / Treatment Rooms] is between 13 and 24
c. Provide six if [ED Exam / Treatment Rooms] is between 25 and 36
d. Provide eight if [ED Exam / Treatment Rooms] is between 37 and 48
hung lavatory @ 13 NSF, ABA clearances, and circulation.
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9. General Exam / Treatment Room, ED (CED21) ........................... 160 NSF (14.9 NSM)
b. Provide two if [ED Exam / Treatment Rooms] is 10 or 11
c. Provide three if [ED Exam / Treatment Rooms] is 12
e. Provide five if [ED Exam / Treatment Rooms] is 21
f. Provide six if [ED Exam / Treatment Rooms] is 22 or 23
g. Provide seven if [ED Exam / Treatment Rooms] is 24
i. Provide nine if [ED Exam / Treatment Rooms] is 34 or 35
j. Provide ten if [ED Exam / Treatment Rooms] is 36
k. Provide eleven if [ED Exam / Treatment Rooms] is between 37 and 44
l. Provide twelve if [ED Exam / Treatment Rooms] is 45
m. Provide thirteen if [ED Exam / Treatment Rooms] is 46 or 47
n. Provide fourteen if [ED Exam / Treatment Rooms] is 48
The General Exam / Treatment Room is used for patient consultation, examination,
and various noninvasive treatments and procedures. The patient care permitted in a
General Exam / Treatment Room is treatments that may require high-level
disinfected or sterile instruments but do not require the environmental controls of a
procedure room. Some examples include blood draws, injections/shots, minor cuts,
and sprains (including wound packing), stitches and casting, minor dermatological
procedures (including removal of skin tags), PICC (percutaneously inserted central
catheter) line placement and removal, and needle biopsies. This room shall be
provided with overhead H-style patient lift systems, capable of 550-pound lifting
capacity, to aid staff in moving patients on/off a stretcher, or recliner. It shall have a
5’-6” diameter clear turning space within the room. Refer to Emergency Department
PG-18-12 Design Guide Section 4 for room template.
10. ED General E/T Room PPE / Equipment Alcove, ED (CED41) ............ 5 NSF (0.5 NSM)
b. Provide two if [ED Exam / Treatment Rooms] is 10 or 11
f. Provide six if [ED Exam / Treatment Rooms] is 22 or 23
i. Provide nine if [ED Exam / Treatment Rooms] is 34 or 35
j. Provide ten if [ED Exam / Treatment Rooms] is 36
k. Provide eleven if [ED Exam / Treatment Rooms] is between 37 and 44
l. Provide twelve if [ED Exam / Treatment Rooms] is 45
m. Provide thirteen if [ED Exam / Treatment Rooms] is 46 or 47
n. Provide fourteen if [ED Exam / Treatment Rooms] is 48
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Patient Area. Refer to Emergency Department PG-18-12 Design Guide Section 4 for
room template.
11. Airborne Infection Isolation (AII)
Exam / Treatment Room, ED (CED27) ........................................ 200 NSF (18.6 NSM)
a. Provide one if [ED Exam / Treatment Rooms] is 3
A negative-pressure Airborne Infection Isolation (AII) E/T Room is designed to isolate
a patient who is suspected of, or has been diagnosed with, an airborne infectious
disease. Therefore, the negative-pressure isolation room, is designed to help
prevent the spread of a disease via respiratory droplets from an infected patient.
This Exam / Treatment Room shall have an Anteroom where all entry/exit of
patients, staff, and equipment into the AII E/T room must pass through. This room
has a dedicated patient Toilet that can only be accessed directly from the AII room.
This room does have special requirements for airflow that are further defined in the
Mechanical Design portion of this Design Guide. Otherwise, this room is equipped
just like a General E/T Room. Refer to Emergency Department PG-18-12 Design
Guide Section 4 for room template.
12. Airborne Infection Isolation (AII) Anteroom, ED (CED28) ........... 170 NSF (15.8 NSM)
template.
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13. Airborne Infection Isolation (AII) Patient Toilet, ED (CED29) ..........60 NSF (5.6 NSM)
template.
14. Mental Health Exam / Treatment Room, ED (CED25) ................. 190 NSF (17.7 NSM)
The Mental Health E/T Room is a diversely designed swing room that can be utilized
as a General E/T Room or one dedicated to patients who are triaged with a mental
health condition. This E/T room is shown to be both right- and left-handed layout.
This is done to provide a central nurse observation desk with direct observation into
two adjacent Mental Health E/T rooms so that these mental health patients can be
monitored 1:1 at all times. Two overhead coiling doors are designed to be open for
access to a sink, supply cart, medical gases, wall-mounted exam light, etc. If needed
these doors can be closed to convert this room quickly for patients that need to be
more isolated or restrained to a stretcher. Refer to Emergency Department PG-18-
12 Design Guide Section 4 for room template.
15. ED MH E/T Nurse Observation Alcove, Clncl Sprt (SC149) ..............10 NSF (1.0 NSM)
To provide a location for clinical observation of patients.
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16. Mental Health Intervention Room, ED (CED26).......................... 115 NSF (10.7 NSM)
The mental health intervention room provides an environment suitable for unstable
situations and rapid medical and psychiatric evaluation of patients in acute crisis and
improves the capacity to safely control the patient; this room shall be located away
from General Waiting. Refer to Emergency Department PG-18-12 Design Guide
Section 4 for room template.
17. ED MH Intervention Room
Nurse Observation Alcove, Clncl Sprt (SC149) ................................10 NSF (1.0 NSM)
This space allows for constant observation of patients in the Mental Health
Intervention Room. Refer to Emergency Department PG-18-12 Design Guide Section
4 for room template.
18. ED MH Patient Toilet, Bldg Sprt (SB190) ........................................60 NSF (5.6 NSM)
19. ED MH Patient Shower, Bldg Sprt (SB151) .....................................70 NSF (6.6 NSM)
Allocated NSF accommodates one accessible shower @ 28 NSF, one accessible
bench @ 16 NSF, ABA clearances, and circulation.
20. Bariatric Patient Exam / Treatment Room, ED (CED23) .............. 190 NSF (17.7 NSM)
A Bariatric Patient Exam/Treatment Room has the same purpose, and design, as the
General E/T Room, except it is to be larger, and be equipped with a heavier capacity
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patient lift to accommodate bariatric patients. Bariatric treatment is the branch of

medicine that deals with the causes, prevention, and treatment of obesity. A
bariatric patient is one that is severely obese, overweight by 100 to 200 lbs., or
having a bodyweight of greater than 300 lbs. A Body Mass Index (BMI) of greater
than 40 is considered bariatric. This room shall be equipped with a bariatric
stretcher and an overhead H-style patient lift system, capable of greater than 750-
pound lifting capacity, to aid staff in moving patients on/off a stretcher. It shall have
a 6’-0” diameter clear turning space within the room. Refer to Emergency
Department PG-18-12 Design Guide Section 4 for room template.
21. ED Bariatric E/T PPE / Equipment Alcove, ED (CED41) ..................... 5 NSF (0.5 NSM)
room template.
22. ED Bariatric Patient Toilet, Bldg Sprt (SB163) .................................75 NSF (7.0 NSM)
Allocated NSF accommodates one bariatric toilet @ 25 NSF, one bariatric lavatory @
21 NSF, ABA clearances, and circulation.
23. GYN Exam / Treatment Room, ED (CED24) ................................ 160 NSF (14.9 NSM)
The GYN Patient Exam / Treatment Room has the same design, as the General E/T
Room, except it has a Toilet / Shower Room directly connected to it. This room shall
be dedicated to Women’s health services but may accommodate other patients, as
necessary. Forensics / SANE examinations shall be performed in this room. Refer to
24. ED GYN Patient Toilet / Shower, Bldg Sprt (SB171) ........................80 NSF (7.5 NSM)
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template.
25. ED GYN E/T PPE / Equipment Alcove, ED (CED41) ........................... 5 NSF (0.5 NSM)
room template.
26. Protective Environment (PE)
Exam / Treatment Room, ED (CED36) ........................................ 200 NSF (18.6 NSM)
A positive-pressure Protective Environment (PE) E/T Room is designed to protect the
profoundly immunosuppressed patient, with prolonged neutropenia, from common
environmental airborne infectious microbes. The primary difference between this PE
room and other E/T rooms is the requirements for filtration and positive air pressure
relative to adjoining spaces. The need for this type of room must be established by
the VAMC as determined by an Infection Control Risk Assessment (ICRA). This room
should be located distally from any AII room. This room is required to have an
Anteroom where all entry/exit of patients, staff, and equipment into the AII room
must pass through. Also, this room has a dedicated patient toilet accessed directly
from the PE room.
27. Protective Environment (PE) Anteroom, ED (CED37) .................. 170 NSF (15.8 NSM)
28. Protective Environment (PE) Patient Toilet, ED (CED38).................60 NSF (5.6 NSM)
29. Eye / ENT Treatment Room, ED (CED16) .................................... 190 NSF (17.7 NSM)
The most common Eye treatments performed in the ED are eyelid repair, drainage of
eyelid abscess, and removal of foreign bodies from eyelids. ENT treatments can
include conditions such as epistaxis (nose bleeds), hearing loss, injuries to the ears,
injuries to the head and neck area, foreign bodies in ears, nose, or throat, facial
fractures, burns involving the nose, ears, or mouth, paralysis of the face, sinus
disorders, dizziness, compromised upper airway, difficulty swallowing, and lumps in
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the neck/throat, among others. For both eye and ENT cases, this room must be
uniquely equipped to treat these types of emergency cases. This Treatment room
may also be utilized as a General E/T Room at surge times or when it is not needed
for these special cases. This room shall be uniquely equipped to treat multiple types
of Eye / ENT emergency cases. This Treatment room may also be utilized as a
General E/T room at surge times or when it is not needed for these special cases.
template.
30. ED Eye / ENT PPE / Equipment Alcove, ED (CED41) ......................... 5 NSF (0.5 NSM)
room template.
31. Orthopedic Treatment Room, ED (CED17) ................................. 190 NSF (17.7 NSM)
The most common types of injuries to be treated in the ED are related to
dislocations and fractures of arms and legs. No open fractures would be treated in
this treatment room, they would be taken to the Resuscitation Room or an
Operating Room (OR) in the VAMC. This room is where casting shall be performed,
either fiberglass or plaster types. If plaster type casting is anticipated, then a larger
sink with a plaster trap must be provided. This room shall have direct access to the
ED Imaging area and /or shall have PACS imaging within this treatment room. Refer
to Emergency Department PG-18-12 Design Guide Section 4 for room template.
32. ED Ortho PPE / Equipment Alcove, ED (CED41) ............................... 5 NSF (0.5 NSM)
Patient Area.
33. Resuscitation Room, ED (CED31) ............................................... 350 NSF (32.6 NSM)
This area is dedicated to the immediate care of patients in cardiac arrest, airway,
breathing, and circulation compromise. The resuscitation area consists of one or
more Resuscitation Rooms with all resuscitative equipment (monitors, defibrillators,
airway, intubation & surgical equipment) available at an arm's distance. The
Resuscitation Room is designed to accommodate a second stretcher for a surge
event, with access to a vertical headwall and realignment of the primary stretcher to
accommodate the secondary one. This room shall have a direct line of sight from the
primary nurse care area and a secondary access directly from the Ambulance/EMS
entrance for quicker access of critical patients. Refer to Emergency Department PG-
18-12 Design Guide Section 4 for room template.
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34. Simulation / Resuscitation Viewing Room, ED (CED49) .............. 180 NSF (16.8 NSM)
This room shall be utilized for staff training and simulation cases. It shall be located
along one wall of the Resuscitation Room with observation windows and audible
two-way communication between both rooms. Refer to Emergency Department PG-
18-12 Design Guide Section 4 for room template.
35. Resuscitation Storage Room, ED (CED32).......................................80 NSF (7.5 NSM)
36. Outbound / Inbound Staging / Holding Bay, ED (CED34) .............. 100 NSF (9.3 NSM)
This room can also serve as the screening location for observation/non-ambulatory
patients. The first Holding Bay will be provided with a ceiling lift system. Ceiling lifts
are to be provided for additional Patient Holding / Transfer bays as determined by a
site needs assessment. (Refer to PG-18-12 Section 2.6.11, Safe Patient Handling).
37. ED Staff Toilet, Bldg Sprt (SB191)...................................................60 NSF (5.6 NSM)
b. Provide four if [ED Exam / Treatment Rooms] is between 13 and 24
c. Provide six if [ED Exam / Treatment Rooms] is between 25 and 36
d. Provide eight if [ED Exam / Treatment Rooms] is between 37 and 48
F. FA 6: STAFF WORK AREA

Open staff work core for each ED module providing workspace and non-public staff
circulation while visually connecting Exam / Treatment Rooms. This space provides for
team huddles and planning, required staff computer access, patient arrival, and
scheduling notifications, etc. Providers may have administrative space within the work
core.
1. ED MD/PA Provider Workstation, Stff Sprt (SS215)........................50 NSF (4.7 NSM)
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2. ED MH Provider Workstation, Stff Sprt (SS215) .............................50 NSF (4.7 NSM)

3. ED Consultant Provider Workstation, Stff Sprt (SS215) ..................50 NSF (4.7 NSM)
4. ED Nurse Workstation, Stff Sprt (SS215) ........................................50 NSF (4.7 NSM)
b. Provide three if [ED Exam / Treatment Rooms] is between 5 and 8
c. Provide four if [ED Exam / Treatment Rooms] is between 9 and 12
d. Provide five if [ED Exam / Treatment Rooms] is between 13 and 16
e. Provide six if [ED Exam / Treatment Rooms] is between 17 and 20
f. Provide seven if [ED Exam / Treatment Rooms] is between 21 and 24
g. Provide eight if [ED Exam / Treatment Rooms] is between 25 and 28
h. Provide nine if [ED Exam / Treatment Rooms] is between 29 and 32
i. Provide ten if [ED Exam / Treatment Rooms] is between 33 and 36
j. Provide eleven if [ED Exam / Treatment Rooms] is between 37 and 40
k. Provide twelve if [ED Exam / Treatment Rooms] is between 41 and 44
l. Provide thirteen if [ED Exam / Treatment Rooms] is between 45 and 48
5. ED Nurse Assistant Workstation, Stff Sprt (SS215) .........................50 NSF (4.7 NSM)
6. ED Social Worker Workstation, Stff Sprt (SS215)............................50 NSF (4.7 NSM)
7. ED Pharmacist Workstation, Stff Sprt (SS215) ................................50 NSF (4.7 NSM)
8. ED Case Manager Workstation, Stff Sprt (SS215) ...........................50 NSF (4.7 NSM)
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9. ED Clerk Workstation, Stff Sprt (SS215) .........................................50 NSF (4.7 NSM)

10. ED Trainee Workstation, Stff Sprt (SS215) .....................................50 NSF (4.7 NSM)
11. Provider Workroom, ED (CED44) ............................................... 120 NSF (11.2 NSM)
A Provider Workroom is typically a glass-enclosed room with open desks, computers,
and PACS system for use by all ED physicians on duty. It shall be located near the
central nurse work area.
12. Tele-Health Room, ED (CED46) .................................................. 120 NSF (11.2 NSM)
13. ED Medication Room, Phrm Svc (SV583) ..................................... 100 NSF (9.3 NSM)
This room shall be under the visual control of the nursing staff. This room will
contain a work counter, a hand-washing sink, a lockable refrigerator, and a locked
storage cabinet for controlled drugs.
14. ED Fast Track Medication Station, Phrm Svc (SV582) .....................40 NSF (3.8 NSM)
This station shall utilize an automated supply dispensing unit and have a hand-
washing sink adjacent to it.
15. ED MH Medication Station, Phrm Svc (SV582) ...............................40 NSF (3.8 NSM)
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16. PPE Storage Room, ED (CED47) ................................................... 100 NSF (9.3 NSM)
17. ED Nourishment Alcove, Clncl Sprt (SC296) ...................................40 NSF (3.8 NSM)
This alcove shall be located near the central nurse work area. It shall contain a work
counter, hand-washing sink, refrigerator, microwave, and storage cabinets. It also
will typically have an ice-maker which must be a self-dispensing type.
18. ED Mobile Equipment Alcove, Clncl Sprt (SC090) ...........................20 NSF (1.9 NSM)
Temporary holding of mobile equipment like specialized supply / treatment carts,
clean linen carts, crash carts, etc.
19. ED Copy / Supply Room, Stff Sprt (SS272) ......................................80 NSF (7.5 NSM)
20. ED Pneumatic Tube Station, Lgstcs Svc (SB652) .............................30 NSF (2.8 NSM)
Allocated NSF provides space for up to three stations.
21. ED Wheelchair / Stretcher / Lift Parking, Bldg Sprt (SB258) ............60 NSF (5.6 NSM)
Locate near the module staff work area.
22. Mobile Equipment Storage Room, ED (CED48)........................... 160 NSF (14.9 NSM)
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G. FA 7: EMERGENCY IMAGING AREA

1. ED Gowned Imaging Patient Waiting, Bldg Sprt (SB001) ................60 NSF (5.6 NSM)
Gowned patient waiting. Allocated space accommodates one standard chair @ 9
NSF, one bariatric chair @ 14 NSF, one accessible space @ 10 NSF, and circulation;
total three people.
2. ED Imaging Patient Dressing Room, Bldg Sprt (SB138) ...................60 NSF (5.6 NSM)
Allocated NSF accommodates one side chair w/arms, one tall cabinet, one bench,
one linen hamper and circulation.
3. ED Imaging Patient Toilet, Bldg Sprt (SB201) .................................60 NSF (5.6 NSM)
4. ED Class 2 Radiology Imaging Room, Imgng Svcs (CI016) ........... 350 NSF (32.6 NSM)
Refer to VA295 PG-18-12 Imaging Services Design Guide, Section 4: Room
Templates.
5. ED Radiology Control Room, Imgng Svcs (CI017) ............................75 NSF (7.0 NSM)
Templates.
6. ED Radiology System Component Closet, Imgng Svcs (CI018) .........20 NSF (1.9 NSM)
Templates.
7. ED Class 1 Ultrasound Scanning Room, Imgng Svcs (CI063) ........ 255 NSF (23.7 NSM)
Templates.
8. ED Ultrasound Patient Toilet, Bldg Sprt (SB201).............................60 NSF (5.6 NSM)
32 of 49
9. ED Ultrasound Storage Room, Imgng Svcs (CI069) .........................80 NSF (7.5 NSM)
10. ED Ultrasound Transducer Room, Imgng Svcs (CI071) ...................80 NSF (7.5 NSM)
11. ED Class 2 CT Scanning Room, Imgng Svcs (CI086) ...................... 600 NSF (55.8 NSM)
Templates.
12. ED CT Control Room, Imgng Svcs (CI087) ................................... 210 NSF (19.6 NSM)
Templates.
13. ED CT System Component Room, Imgng Svcs (CI088) ................... 105 NSF (9.8 NSM)
Templates.
14. ED CT Patient Toilet, Bldg Sprt (SB201) ..........................................60 NSF (5.6 NSM)
15. ED CT Storage Room, Imgng Svcs (CI091) .......................................80 NSF (7.5 NSM)
16. ED CT Automated Supply Dispenser Unit (ASDU) Alcove,
Imgng Svcs (CI539) .......................................................................20 NSF (1.9 NSM)
With the increasing usage of automated dispensing machines for more accurate
inventory control, each imaging modality is assigned ASDUs based on typical storage
needs for the modality and the clinical usage. It is the intention that each imaging
room be provided with an ASDU alcove proximate to the staff core entrance to the
control room / alcove. When multiple modalities share a common staff core, ASDU
alcoves may be merged (instead of repeated individual alcoves), and individual ASDU
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devices may be used for storage of materials for more than one imaging device or
modality.
17. ED Clean Utility Room, Lgstcs Svc (SB737) .....................................60 NSF (5.6 NSM)
This area provides storage for sterile and non-sterile medical supplies.
18. ED Soiled Utility Room, Lgstcs Svc (SB743) ....................................80 NSF (7.5 NSM)
19. ED Lead Apron Alcove, Imgng Svcs (CI521) ....................................15 NSF (1.4 NSM)
20. ED Imaging PPE Alcove, SPS (SC856) .............................................20 NSF (1.9 NSM)
Patient Area.
21. ED Imaging Staff Workstation, Stff Sprt (SS218) ............................56 NSF (5.3 NSM)
22. ED Imaging Staff Toilet, Bldg Sprt (SB191) .....................................60 NSF (5.6 NSM)
23. ED Imaging Patient Wheelchair / Stretcher / Lift Parking,
Bldg Sprt (SB258) ..........................................................................60 NSF (5.6 NSM)
24. ED Portable Imaging Equipment Alcove, Clncl Sprt (SC180) ............20 NSF (1.9 NSM)
H. FA 8: AMBULANCE / EMS AREA

1. EMS Decontamination Shower, ED (CED52) ............................... 120 NSF (11.2 NSM)
Decontamination is defined as the process of removing or neutralizing a hazard from
the patient. The Shower room shall accommodate a patient on a stretcher. The
exterior entrance into this area must be located a minimum of 30 feet away from
the EMS/Ambulance entrance into the ED. Showers shall be designed with multiple
showerheads and/or heads on flexible hoses to adequately wash all parts of the
patient’s body. Refer to Emergency Department PG-18-12 Design Guide Section 4 for
room template.
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2. EMS Decontamination Patient Changing Room, ED (CED53) ...... 120 NSF (11.2 NSM)
template.
3. EMS Decontamination Storage Room, ED (CED54) ........................80 NSF (7.5 NSM)
4. EMS Patient Drop-off, ED (CED51) .................................................... 0 NSF (0 NSM)
The exterior space shall be a covered canopy or enclosed garage. It may be designed
in either drive-thru or back-in unloading configurations.
5. EMS Drop-off Storage Room, ED (CED55) ......................................80 NSF (7.5 NSM)
6. ED EMS Vestibule, Bldg Sprt (SB291) ........................................ 120 NSF (11.2 NSM)
7. ED EMS Wheelchair / Stretcher / Lift Parking,
Bldg Sprt (SB258) .........................................................................80 NSF (7.5 NSM)
a. Provide one at 120 NSF if [ED Exam / Treatment Rooms] is between 25 and 48
8. EMS Staging, ED (CED56) ............................................................ 100 NSF (9.3 NSM)
The EMS Staging area is an open bay configured to temporarily hold a patient either
arriving at or departing the ED. This staging area may be combined with other
outbound holding bays for patients waiting to be transferred to another area within
the VAMC. For incoming patients arriving by ambulance, that may need to be held
here before being moved into the Resuscitation Room or an E/T room.
9. EMS Staff Workstation, ED (CED57) ..............................................55 NSF (5.2 NSM)
10. EMS Supply Room, ED (CED58) .....................................................60 NSF (5.6 NSM)
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11. ED EMS Staff Toilet, Bldg Sprt (SB191) ..........................................60 NSF (5.6 NSM)
12. EMS Ambulance Garage, ED (CED59) ........................................ 850 NSF (79.0 NSM)
I. FA 9: SUPPORT AREA
1. Medical Supplies Storage Room, ED (CED61) ................................80 NSF (7.5 NSM)
2. ED Satellite Sterile Supply Room, Lgstcs Svc (SB737) ......................60 NSF (5.6 NSM)
3. ED Clean Linen Alcove, EMS (SC467) .............................................30 NSF (2.8 NSM)
4. ED Soiled Utility Room, Lgstcs Svc (SB743) ....................................60 NSF (5.6 NSM)
5. ED Wheelchair / Stretcher / Lift
Storage Room, Bldg Sprt (SB259) ..................................................80 NSF (7.5 NSM)
6. Emergency Cart Alcove, ED (CED62) ..............................................20 NSF (1.9 NSM)
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7. Clean Equipment Storage Room, ED (CED63) ............................... 100 NSF (9.3 NSM)
8. General Storage Room, ED (CED66) ........................................... 160 NSF (14.9 NSM)
General ED storage space.
9. ED Full Gas Cylinder Storage Room, Lgstcs Svc (SB541) ..................40 NSF (3.8 NSM)
Full Oxygen tank storage space.
10. ED Empty Gas Cylinder Storage Room, Lgstcs Svc (SB551) ..............40 NSF (3.8 NSM)
Empty Oxygen tank storage space.
11. ED Trash / Recycling Holding, Bldg Sprt (SB280) ............................60 NSF (5.6 NSM)
12. ED Housekeeping Aides Closet (HAC), Bldg Sprt (SB244) ...............80 NSF (7.5 NSM)
J. FA 10: STAFF AND ADMINISTRATIVE AREA

1. ED Director Office, Stff Sprt (SS204) ............................................ 100 NSF (9.3 NSM)
Allocated NSF per OMB M-12-12 Memorandum Freeze the Footprint (RTF) in Federal
Facilities.
2. ED Assistant Director Office, Stff Sprt (SS204).............................. 100 NSF (9.3 NSM)
Facilities.
3. ED Administrative Officer (AO) Office, Stff Sprt (SS204) ............... 100 NSF (9.3 NSM)
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Facilities.
4. ED Nurse Manager Office, Stff Sprt (SS205) ...................................80 NSF (7.5 NSM)
Facilities.
5. ED Assistant Nurse Manager Office, Stff Sprt (SS205) ....................80 NSF (7.5 NSM)
Facilities.
6. ED Social Worker Office. Stff Sprt (SS205)......................................80 NSF (7.5 NSM)
Facilities.
7. ED Pharmacist Office, Stff Sprt (SS205) ..........................................80 NSF (7.5 NSM)
Facilities.
8. ED Program Support Assistant (PSA)
Workstation, Stff Sprt (SS218) .......................................................56 NSF (5.3 NSM)
Facilities.
9. ED Administrative Support Workstation, Stff Sprt (SS218) .............56 NSF (5.3 NSM)
Facilities.
10. ED Staff Breakroom, Stff Sprt (SS262) ........................................ 160 NSF (14.9 NSM)
The Emergency Department requires the use of a Staff Break Room within its
department. Unlike other departments of the VAMC, the staff is on duty 24/7 so
immediate access to a Break Room is essential quick breaks from their work routine.
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This room would preferably have exterior windows for access to natural daylight.
This room should be equipped with storage cabinets, a sink, refrigerator, icemaker,
microwave oven, and coffee maker. It should be provided with tables that can
remain individual or ganged together for larger groups to gather at.
11. ED Female Staff Locker Room, Stff Sprt (SS232) ......................... 150 NSF (14.0 NSM)
Locate this space adjacent / near the ED Female Staff Shower.
12. ED Female Staff Toilet, Bldg Sprt (SB202) ......................................60 NSF (5.6 NSM)
13. ED Female Staff Shower, Bldg Sprt (SB173)....................................70 NSF (6.6 NSM)
bench @ 16 NSF, ABA clearances, and circulation. Locate this space adjacent / near
the ED Female Staff Locker.
14. ED Male Staff Locker Room, Stff Sprt (SS241) ............................ 150 NSF (14.0 NSM)
Locate this space adjacent / near the ED Male Staff Shower.
15. ED Male Staff Toilet, Bldg Sprt (SB203) ..........................................60 NSF (5.6 NSM)
16. ED Male Staff Shower, Bldg Sprt (SB184) .......................................70 NSF (6.6 NSM)
bench @ 16 NSF, ABA clearances, and circulation. Locate this space adjacent / near
the ED Male Staff Shower.
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17. ED Staff Conference Room, Educ Svc (SS101) ............................. 240 NSF (22.3 NSM)
This space is essential for training and staff meetings. This room would preferably
have exterior windows for access to natural daylight. 240 NSF accommodates six
chairs @ 7.5 NSF each, two tables at 10 NSF each, one credenza @ 8 NSF, and
circulation; total six people; 300 NSF accommodates ten chairs @ 7.5 NSF each, four
tables at 10 NSF each, one credenza @ 8 NSF, and circulation; total ten people; 500
NSF accommodates ten chairs @ 7.5 NSF each, four tables at 10 NSF each, one
credenza @ 8 NSF, and circulation; total ten people; and 675 NSF accommodates
twenty chairs @ 7.5 NSF each, sixteen tables at 10 NSF each, two credenzas @ 8 NSF
each, and circulation; total twenty people.
18. ED On-Call Bedroom, Stff Sprt (SS287) ...........................................90 NSF (8.4 NSM)
19. ED On-Call Toilet / Shower, Bldg Sprt (SB196)................................85 NSF (7.9 NSM)
K. FA 11: EDUCATION AREA

1. ED Staff Training / Classroom, Educ Svc (SS111)......................... 545 NSF (50.7 NSM)
Minimum allocated NSF accommodates eight chairs @ 7.5 NSF each, four tables at
10 NSF each, one credenza @ 8 NSF, one lectern @ 9 NSF and circulation; total eight
people; 630 NSF accommodates sixteen chairs @ 7.5 NSF each, eight tables at 10
NSF each, one credenza @ 8 NSF, one lectern @ 9 NSF and circulation; total sixteen
people; and 715 NSF accommodates twenty-four chairs @ 7.5 NSF each, twelve
tables at 10 NSF each, two credenzas @ 8 NSF each, one lectern @ 9 NSF and
circulation; total twenty-four people.
2. ED Training Materials Storage Room, Educ Svc (SS186) ..................80 NSF (7.5 NSM)
L. SEPS IMPORTER SHORTCUTS

The following shortcuts are used in the Room Criteria Statements in the Emergency
Department Functional Areas. These shortcuts are used during upload of this document
into the Space and Equipment Planning System (SEPS) software during implementation
of the space planning parameters contained herewith to allow for mathematical or
40 of 49
logical calculations to be performed. Input Data Statements (IDSs), Rooms or a partial

calculation formula can have a shortcut.
1. Annual Emergency Department (ED) Clinic Stops (Stop Code 130) projected: [How
many Emergency Department (ED) annual Clinic Stops (Stop Code 130) are projected
for this facility? (W)]
2. ED Exam / Treatment Rooms: [Number of ED Exam / Treatment Rooms, Clncl Sprt
(SC107)]
6. PLANNING AND DESIGN CONSIDERATIONS

A. GENERAL
1. Refer to Department of Veterans Affairs (VA) Office of Construction Facilities
Management (CFM) Handbooks, Standards, Standard Details, and Design Guides for
technical criteria available at the VA Technical Information Library (TIL).
2. Refer to Emergency Department PG-18-12 Design Guide Section 2: Narrative; Sub-
Section 2.2: Emergency Department Operations & 2.5: Planning Emergency
Department Facilities.
3. Refer to Section 8: Functional Diagrams in this document for illustration of the
following Planning and Design Considerations.
4. Provide proper visual control of patient areas by ED staff, including circulation
spaces, to assist in the monitoring and caring for the elderly patient.
5. Provide 100 percent accessibility to all patient areas and circulation spaces indoors
as well as at access points to facility.
B. RECEPTION / PUBLIC AREA
1. The Security Station shall be positioned to allow “back door” exit to access a corridor
to the main ED without traveling through the General Waiting area. There shall be a
clear and direct path from the entry/metal detectors to the First Look reception area
(without walking through General Waiting).
2. Public areas are developed for safe and secure environment for Veterans, staff,
families, and visitors that arrive at the ED with patients. The emphasis is on
developing a safe and secure environment for the public. Patients are to be
expedited to triage or a care area and moved ahead in the process. it is the intent
that limited patients be placed back in the public area and, instead, move forward to
care areas or internal waiting areas as part of expediting their access to the
provider/physician.
3. The General Waiting shall have direct access to outside windows for daylight. It must
be visually observable from the Reception desk and First Look Station. Provision shall
be provided for public toilets, drinking water, and public communication services.
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C. RECEPTION / PUBLIC / PATIENT AREA

1. The rooms/spaces of the ED are organized in ten different functional areas. These
areas begin to define the natural organization of the department. Then depending
on the size of the ED, will change the layout and modularity of the department. The
Reception/Public Area, Security/Police Area, and Patient Assessment Area all work
together as the public facing part of the ED.
2. The Patient Assessment Area is the portal to the rest of the ED and connects the
patient to the clinical and staff areas. The clinical areas shall be designed in a
modular approach with the basic planning module being twelve (12) E/T Rooms
physically organized in groups of four (4) E/T rooms to maximize the staffing ratio of
1 nurse to 4 patients.
3. Decontamination showers shall be designed with multiple showerheads and/or
heads on flexible hoses to adequately wash all parts of the patient’s body. The
shower room must accommodate a patient on a stretcher also. The patient then is
moved into a Decontamination Patient Changing Room to dry off and put on a
hospital-provided gown before being moved to an E/T Room.
4. Placement of the large Bariatric Patient E/T Room(s) shall be considered near the
Resuscitation Room allowing it to be utilized as overflow resuscitation. If considered,
a Simulation/Resuscitation Viewing Room, for staff training, shall be located
adjacent to one side of the Resuscitation Room, for direct visual observation and
training.
5. A Results Pending Waiting Room needs to be in a highly visible area where clinical
personnel can maintain visual control of those utilizing the space. Patients may wait
here for final discharge instructions. This space shall be near a consultation room so
results and discharge instructions can be delivered in a confidential environment.
6. A Triage Room is where a nurse will assess patients' severity of injury or illness
within a short time after their arrival, assign priorities, and transfer each patient to
the appropriate place in the ED for treatment. The Triage Room shall be designed
with direct access and visual observation of the ED Waiting Room. If possible, the
Security Station shall have visibility through the glass-front triage room to observe
first interaction between nurse and patient.
7. The Triage Room is also designed to have flow-through patient movement, so they
enter directly from the Waiting Room and exit directly into the clinical area of the
ED. Generally, the patient will be seated in a reclining type of exam chair.
8. The General E/T Room is used for patient consultation, examination, and various
noninvasive treatments and procedures. There is an expectation of physical contact,
or “laying on of hands,” between the caregiver and patient. This room is the basic
building block of the clinical treatment rooms within the ED.
9. A negative-pressure Airborne Infection Isolation (AII) E/T Room is designed to isolate
a patient who is suspected of, or has been diagnosed with, an airborne infectious
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disease. This room is required to have an anteroom where all entry/exit of patients,
staff, and equipment into the AII room must pass through. Also, this room has a
dedicated toilet that can only be accessed from within the AII room.
10. A positive-pressure Protective Environment (PE) E/T Room is designed to protect the
immunosuppressed patient. This room shall be located distally from any Airborne
Infection Isolation E/T Room.
11. The Mental Health Intervention Room shall be located away from the waiting area
and have a Nurse Workstation adjacent. While it is not a seclusion/restraint room, it
shall meet the standards of the Mental Health Intervention Room for construction,
equipment, and furnishings, outlined in the current Mental Health Environment of
Care Checklist.
12. The Mental Health E/T Room is a diversely designed swing room that can be utilized
as a General E/T Room or one dedicated to patients who are triaged with a mental
health condition. This E/T room is shown to be both right- and left-handed layout.
This is done to provide a central nurse observation desk, for two people, with direct
observation into two adjacent Mental Health E/T Rooms.
13. Most EDs are being designed with internal imaging services. It is still important to
have an understanding between the ED and imaging about the use, or back-up use,
of potentially shared diagnostic rooms.
14. The Emergency Imaging Area may be part of the main VAMC Imaging Services if it is
immediately adjacent to the Emergency Department and in a smaller ED. In a
medium to large ED, Imaging Areas will be dedicated to the Emergency Department.
Gowned Imaging Patient Waiting shall be on the edge of the imaging area closest to
the initial assessment area and fast-track care area. The patient dressing area shall
be adjacent to the Gowned Imaging Patient Waiting area and have access to the ED
Imaging Toilet Room.
D. AMBULANCE / EMS AREA
1. Ambulance / EMS entry shall have a covered canopy or enclosed garage depending
on local facility requirements and geographic location. Drop-off canopies may be
designed in either drive-thru or back-in unloading configurations; garages shall be
designed in drive-thru configurations.
2. The Emergency Medical Services (EMS) Outbound / Inbound Staging / Holding Room
is an open bay configured to temporarily hold a patient either arriving at or
departing the ED. This staging area may be combined with outbound patient holding
room / bay for patients waiting to be transferred to another area within the VAMC.
For incoming patients arriving by ambulance, that may need to be held here before
being moved into the Resuscitation Room or an E/T Room.
E. STAFF WORK AREA
1. Staff/providers need to be in a position to visually monitor and control the clinical
areas in the best interest of clinical safety and overall security.
43 of 49
2. Open work/charting area shall be available with visual control of triage rooms and
access paths back into ED. In smaller EDs the work/charting area may be the central
ED staff workstation.
3. Consideration shall be given to how a main ED staff work area can be positioned to
allow for visual control of the EMS Vestibule. EMS entry point shall have direct
access to wheelchair and stretcher storage, EMS Staff Workstation, EMS Supply
Room, and EMS Staff Toilet. EMS Staff Workstation shall be positioned to maintain a
view of ambulances. EMS crews may have exterior access to EMS Drop-off Storage
Room.
4. Provide an open staff work core for each ED module (about 12 E/T rooms) providing
workspace and non-public staff circulation while visually connecting exam and
treatment rooms. This space provides for team huddles and planning, required staff
computer access, patient arrival, and scheduling notifications, etc.
5. A Provider Workroom is typically a glass-enclosed room and needs to be located
near the central nurse work area. The design may include one of these workrooms
per 12 E/T room module, or they could be combined at an intersection between two
modules.
6. A Medication Room or Alcove will typically be a room which shall be under the visual
control of the nursing staff. Where one or more automated supply dispensing units
are present, the room needs to be designed with space to prepare medications.
7. Staff work areas in a care module shall not be isolated from other care areas and
shall have visibility to adjacent staff work areas in other care modules. Isolation
rooms and internal ED waiting areas shall be located on the side of the care module
closest to the upfront assessment area or just off the main circulation corridor to
allow for immediate access within a care module.
F. LAYOUT
1. Provide a direct access from First Look Station and Triage Room(s) to EMS
Decontamination facilities.
2. Triage rooms shall “flow through” with accessibility from General Waiting with
separate “back door” for flow to main ED Patient Care areas.
3. First Look shall have an escape path back into the ED in the event of dangerous
situation. Direct access to PPE, patient toilet/shower and support spaces. In smaller
EDs these components may be shared with main ED care area(s).
4. Fast-Track shall be an area that can flex with the main emergency department care
area. Fast-Track shall be considered in an area close to the assessment area allowing
rapid turnaround for non-urgent patients. An internal ED patient accessible waiting
area shall be near fast track to allow non-urgent patients to await testing results.
This space shall be visible to staff work areas to maintain visual control of
patients/families
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5. Locate Eye/ENT and Orthopedic Treatment Room(s) as well as the GYN and the
Airborne Infection Isolation (AII) E/T Room(s) Orthopedic Treatment Rooms near the
Fast Track E/T Room(s).
6. Orthopedic Treatment Room, in the main ED, shall be near the imaging area.
7. If the number of the Mental Health E/T Rooms is large, consider creating a dedicated
mental health care zone, which shall remain adjacent with the main ED Patient Area.
This separate-but-adjacent care area would allow staff to flex in and out of the
mental health area in support of patient care.
8. Direct access from the Reception / Public Area to the Mental Health (MH) Sally Port
is a priority. The MH Sally port shall have direct access to a MH Private Search Room.
Patient Belongings Storage shall be near or adjacent to the Sally port and MH Private
Search Room. Toilet/shower shall be in the proximity of ED Mental Health
Intervention Room or within a secured ED mental health unit.
9. A key priority is to maintain a visual connection from the MH work area to adjacent
ED staff work areas (nurse stations) in an adjacent care area. The intent is that no
staff are isolated in the MH area without visual connection to other team members.
There shall be no “dead-end” corridors. Escape paths for staff need to be considered
if the area will be “locked-down”. Consider escape paths from the main workarea to
outside the unit. Support areas (clean, soiled, etc.) shall be secured access and must
include escape paths out the backside of support spaces, so no staff is trapped in the
support areas.
10. The Resuscitation Room(s) shall have direct accessibility from the EMS/ambulance
Entry. Central staff work areas shall have direct visual control of the Resuscitation
Room(s).
11. Resuscitation Storage Room shall be adjacent to the Resuscitation Room.
Consideration shall be given to access this storage room from inside the
Resuscitation Room and from the main corridor allowing staff to access this storage
room even while resuscitation is taking place.
12. Design shall accommodate patient privacy and confidentiality in all areas, and in
reception and patient care areas. This includes visual and auditory considerations.
13. Corridors shall be designed to a minimum of 8 feet clear width to accommodate
passage of equipment or beds and two stretchers and/or wheelchairs.
14. The main circulation corridor concept provides a circulation path that allows
patients to come from the assessment area and circulate to any care module
without traversing through other care modules. The main corridor also allows
patients to come from any care module, access imaging, and return to their care
module without traversing through other care modules.
45 of 49
7. FUNCTIONAL RELATIONSHIPS
Emergency Department (ED) to Patient Care / Patient Care Support Services
SERVICES FUNCTIONAL RELATIONSHIP
CLNCL: Pulm Svc: Pulmonary / Respiratory Care 1
CLNCL: Pulm Svc: Bronchoscopy 1
IP: ICU PCUs 1
CLNCL: Imgng Svcs: Radiography 2
CLNCL: Imgng Svcs: Ultrasound 2
CLNCL: Path Svc: Autopsy 2
CLNCL: Surg Svc: Inpatient Surgery 2
CLNCL: Surg Svc: Ambulatory Surgery 2
IP: MH PCUs 2
BLDG SPRT: Police & Security 2
VET SPRT: PHRM Svc: Outpatient 2
CLNCL: Cardiology 3
CLNCL: Dialysis 3
CLNCL: EEG / EMG 3
CLNCL: Eye Clnc: Ophthalmology 3
CLNCL: Eye Clnc: Optometry 3
CLNCL: GI-Endoscopy 3
CLNCL: Path Svc: Clinical Pathology 3
CLNCL: Wm Vet Svc: Model 2 3
CLNCL: Wm Vet Svc: Model 3 3
IP: MS PCUs 3
BLDG SPRT: ENG: Biomedical Repair 3
CLNCL: Imgng Svcs: Breast Imaging 3
BLDG SPRT: Lobby 3
CLNCL SPRT: OIT: Server 3
CLNCL SPRT: OIT: Telecommunications 3
STFF SPRT: HAS: Health Information Management Section
3
(HIMS)
Functional Relationship Key:
1 High
2 Moderate
3 Minimal
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8. FUNCTIONAL DIAGRAMS
Diagram 1: Twelve Exam / Treatment (E/T) Rooms
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Diagram 2: Twenty-four Exam / Treatment (E/T) Rooms
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Diagram 3: Thirty-two Exam / Treatment (E/T) Rooms
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PG-18-9 – SPACE PLANNING CRITERIA March 1, 2022

256 – Emergency Department (ED)

CHAPTER 256: EMERGENCY DEPARTMENT (ED)

1. PURPOSE AND SCOPE

3. OPERATING RATIONALE AND BASIS OF CRITERIA

TABLE 1: ALLOCATION OF ED EXAM / TREATMENT ROOMS – RANGES 1 -24

TABLE 2: ALLOCATION OF ED EXAM / TREATMENT ROOMS – RANGES 25 -48

CHART 1: FUNCTIONAL AREA AGGREGATE NSF BY RANGE

Reception / Public Area Security / Police Area Patient Assessment Area

4. INPUT DATA STATEMENTS (IDS)

5. SPACE PLANNING CRITERIA

C. FA 3: SECURITY / POLICE AREA

glass-enclosed Security Room is up to the discretion of an individual VAMC to

D. FA 4: PATIENT ASSESSMENT AREA

room is also designed to have flow-through patient movement, so they enter

patient lift to accommodate bariatric patients. Bariatric treatment is the branch of

Refer to Emergency Department PG-18-12 Design Guide Section 4 for room

F. FA 6: STAFF WORK AREA

2. ED MH Provider Workstation, Stff Sprt (SS215) .............................50 NSF (4.7 NSM)

9. ED Clerk Workstation, Stff Sprt (SS215) .........................................50 NSF (4.7 NSM)

G. FA 7: EMERGENCY IMAGING AREA

H. FA 8: AMBULANCE / EMS AREA

J. FA 10: STAFF AND ADMINISTRATIVE AREA

K. FA 11: EDUCATION AREA

L. SEPS IMPORTER SHORTCUTS

logical calculations to be performed. Input Data Statements (IDSs), Rooms or a partial

6. PLANNING AND DESIGN CONSIDERATIONS

C. RECEPTION / PUBLIC / PATIENT AREA

Diagram 2: Twenty-four Exam / Treatment (E/T) Rooms

Diagram 3: Thirty-two Exam / Treatment (E/T) Rooms

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