After seven years of planning, approvals and a building process that included continued construction during a worldwide pandemic, the Brigham’s Emergency Department (ED) expansion project celebrated the end of its final phase of construction this month.
In addition to doubling the ED’s total square footage and creating another 30 beds, the expanded space boasts a new trauma suite, a dedicated area for behavioral health patients and additional emergency imaging capabilities.
“We’re excited to formally open our new Emergency Department, which will allow us to continue to support our patients who need emergency medical care,” said Robert S.D. Higgins, MD, MSHA, president of the Brigham and executive vice president at Mass General Brigham. “This new, state-of-the-art space is part of our ongoing commitment to meet the needs of our community and improve our patients’ experience.”
The expansion will improve efficiency for ED staff, support a reduction in wait times and provide a more comfortable, healing environment for patients and families, explained Michael J. VanRooyen, MD, MPH, chair of the Brigham’s Department of Emergency Medicine and enterprise chief of Emergency Services at Mass General Brigham.
“We focused on designing a space to both provide the best health care experience possible to our patients and to support our staff,” VanRooyen said. “It’s not just about creating more space but also prioritizing the workflow and the patient journey to make sure we’re leading the way and being an example for other emergency departments in the future.”
The COVID-19 pandemic disrupted numerous facets of hospital operations throughout the year, and the ED was no exception. However, through the work of hospital and ED leadership, Brigham Infection Control experts, construction teams and local regulatory agencies, the construction project continued through this difficult stretch of time.
“We maintained the highest safety standards despite the unique challenges posed by the COVID-19 pandemic,” said Sonal V. Gandhi, vice president of Real Estate, Planning and Construction. “It is a testament to the innovative and dedicated team of professionals who work tirelessly to meet the critical need for increased capacity while providing the best health care experience for our patients, families, surrounding community and staff.”
The three-phase construction project broke ground in 2019 and has resulted in a 26,000-square-foot expansion of the ED’s footprint. The renovation included the creation of an additional 32 exam rooms, an increase from 49 to 81 beds, two state-of-the-art trauma rooms, two advanced X-ray rooms, an additional CT scanner and a second ultrasound room.
The project also included a new entrance, security and check-in desk, waiting room, care initiation and triage rooms, as well as an eight-bed behavioral health observation unit. Care initiation and triage rooms make it possible to quickly advance patient care during longer wait times and for low-acuity patients who can be seen and discharged by medical staff without waiting longer for care elsewhere in the department. A specialized oncology unit catering to the unique needs of patients with cancer emergencies will open at a later date.
These resources could not become available at a more important time, as emergency departments across the city, including the Brigham’s, continue to face high censuses and inpatient boarding challenges, said Christopher Baugh, MD, MBA, vice chair of Clinical Affairs for Emergency Medicine.
“Through this expansion, our team looks forward to better serving patients and families,” Baugh said. “This expansion is also an important part of our mission to ensure that we are supporting our surrounding community — especially as it pertains to serving those patients for whom it could be lifechanging or lifesaving to have access to the highly complex and specialized care that we provide here at the Brigham.”
Specialized Care for Behavioral Health Patients
The behavioral health observation unit has been environmentally tailored to suit the needs of this patient population by providing safe and private space, with softer lighting and reduced noise.
“Improving patient privacy and making sure we provide our behavioral health population with the most respectful space, tailored to their needs, was a top priority for the ED’s nurses, who have been involved in every aspect of the new space,” said Janet Gorman, MM, BSN, RN, associate chief nursing officer of the ED.
Equipped with its own nursing station, medication room and a dedicated team of providers, the unit was designed to ensure behavioral health patients receive personalized care, explained Dana Im, MD, MPP, MPhil, director of Quality and Safety and director of Behavioral Health for Emergency Medicine.
Patients in the unit also receive a “comfort menu,” which invites them to access a variety of items and services to support a comfortable stay — including earplugs, books and magazines, crossword puzzles, snacks, personal hygiene items and sleep aids. The handout also provides relaxation tips, such as breathing exercises, as well as information about safety and privacy guidelines. Patients are also given an opportunity to contribute to their care plan by sharing their preferred calming strategies and which conditions trigger emotional discomfort.
“Our old ED environment was not conducive to behavioral health care, and we also felt our staff was being pulled in so many directions. It’s really hard to care for an escalating patient while EMS stretchers are passing by every five minutes and trauma teams are activated right next door,” Im said. “We really wanted to create a space that was internal to the ED but separate from all the other activity so that we can provide dedicated care to our behavioral health patients.”
One notable aspect of the Brigham’s behavioral health unit is it is staffed by a multidisciplinary team of ED clinicians, who work closely with social workers, psychiatrists and, most recently, a psychiatric occupational therapist, Im explained. The multidisciplinary team focuses on acute stabilization, treatment and reassessment of both medical and psychiatric illnesses.
Additionally, in anticipation of the unit’s opening, Im and her colleagues implemented interdisciplinary rounds in the ED for behavioral health patients. Rounding in the traditional sense is uncommon in EDs, but the team recognized a need to bring together clinical and nonclinical staff to optimize care for this patient population.
“It’s really a great opportunity for us to come together as a team for patients. Centralizing the care in the new unit will now make it even easier for us to do so,” Im said. “We see a lot of medically complex psychiatric patients, and we’re now uniquely equipped to provide a higher quality of care to our behavioral health patients.”
ED Renames Pods to Honor Boston Marathon Route
Included in the project is a new naming convention for the six areas (pods) that make up the ED. Those pods are now named after the Boston streets that are connected to the final stretch of the Boston Marathon: Arlington, Berkeley, Clarendon, Dartmouth, Exeter and Fairfield.
The naming convention pays homage to the victims of the 2013 Boston Marathon bombing and honors the caregivers, including those in the Brigham’s ED, who played a critical role in responding to the tragic event and caring for the wounded.