Emergency Departments: Universal Design Technical Sketch

UD Dementia Friendly Design Guidance

A. The approach to the ED entrance should consist of a legible route leading to a clearly identifiable and easily located entrance space. This strengthens legibility, affords a transition space between inside and outside, and provides a gathering space that may be a welcome respite from the ED.

B. Provide an easily located and identifiable public entrance to the ED. This entrance should be highlighted and clearly differentiated from the ambulance entrance through the use of colour or other visual cues. Provide a door that is accessible, easily operated and understood.

C. At the same time the ambulance entrance can be visually down-played to ensure it doesn’t attract the attention of the public as they approach the ED.

D. Ensure the reception area is directly visible from the entrance area and is accessible, easily understood and used.

E. Provide a spacious waiting area with generous circulation area and clearance between seating.

F. Consider a distinct seating area with some level of separation where a person who is more sensitive to environmental stress such as noise or activity can find some respite in a busy ED waiting area.

G. Provide views to the calm exterior spaces and artwork to help create a more calming environment.

H. Locate public toilets so that they are easily identified upon entry, and that are accessible and easy to use.

I. While the interior of the ED is typically a complex setting, provide a clearly articulated and legible main circulation route for patients. This may provide patients with a better sense of comprehensibility and manageability in a situation that is largely out of their control.

J. While the ED is often unavoidably hectic due to emergency situations, careful use of artificial lighting and the reduction of noise through sound absorbing materials can help mitigate environmental stress.

K. Use distinct and contrasting colours on doorframes, doors, or wall reveals to identify patient areas or rooms, while simultaneously disguising non-patient rooms by painting doors or frames to match background.

L. Provide natural light within the core of the ED to help orientate patients to the time of day and if possible provide views to the exterior to help relieve the intensity of the ED experience.

M. Use contrasting colours or tones to distinguish the floor from the walls. Similarly, use contrasting colour on the skirting boards to provide a visual break between the walls and the floors to ensure greater visual contrast.

N. All floor finishes should be non-slip, non-glare, and avoid strong patterns or sharp tonal or colour contrast. The avoidance of contrast is very important at door thresholds to prevent those with visual or cognitive impairments misinterpreting this contrast as a step.

O. Select ED bays that can be designated for distressed or disoriented patients. These bays should provide a balance, as much as possible, between good visual access and observation from the main nurse’s station, proximity to a toilet, and a calm location.

P. The designated bays should be uncluttered, provided with seating for an accompanying person, and if possible fitted with a privacy screen to provide some level of acoustic separation from the ED floor.

Q. Provide enough toilets and locate them so that they are within easy reach of the patients within the ED bays.

R. The ED may be confusing and stressful place for a person with dementia, which might be alleviated through the accompaniment of a familiar and trusted person. Therefore, space and supports for an accompanying person throughout the ED will have benefits for both the patient and for staff. This may simply consist of sufficient seating in the waiting area, or enough space and a seat within an ED bay so that an accompanying person can remain the patient’s side without getting in the way of medical staff.