A growing population and urbanization are placing increased the strain on hospital emergency departments, many of which are not equipped to handle the number of admissions they receive.

In South Australia, the Flinders Medical Centre and the Royal Adelaide Hospital have long been experiencing overcrowding in emergency wards. The nurses union recently met with SA health to discuss measures to resolve the issue.

Rob Bonner of the Nursing and Midwifery Federation says the government has yet to implement all of the recommendations made in a review of hospital emergency departments.

“It’s about the environment in which those nurses are struggling to meet patients’ care needs so whether you’re in corridors, whether you’re delivering care in a waiting room,” said Bonner.

The Royal Darwin Hospital (RDH) is experiencing similar issues. Recent figures showed the hospital was not meeting key performance benchmarks due to increased demand.

The RDH is set to undergo a $22 million dollar upgrade beginning this month which will include more emergency department beds and two new operating theatres.

Northern Territory Health Minister Robyn Lambley says the upgrade is “well overdue.”

As hospitals try to cope with demand, hospital design plays a crucial role in the staff’s ability to work effectively.

Perkins + Wil architect Jim Bynum has 20 years’ experience in healthcare architecture and says there are several design principles that can be used to maximise the design functionality of new or updated emergency wards.

Bynum stresses the importance of ‘flexible use planning’ which is a system that can alter as needs change because rooms are not locked into a specific conformation.

The longevity of the emergency ward must be considered during expansions or upgrades with an intended lifespan of 50 years.

Bynum says the right emergency department design can allow the same number of staff to be more productive. Communication about wants and needs of those using the space will ensure a functional design well into the future as well as increased patient and staff satisfaction.

Essentials in Emergency Ward Design

emergency ward design


Care areas should be exposed to daylight to minimise staff and patient disorientation and provide a link to the outdoors.

Sound Control

The transmission of sound should be minimised in all areas to ensure privacy and reduce stress.

Wall Finish and Floor Covering

As machines, beds and wheelchairs can all cause damage to interior walls, buffer rails should be used on walls.

Floor coverings in all treatment and waiting areas should include a durable, non-slip surface that is easy to clean and impermeable to water and bodily fluids.

An Emergency Department Where Staff Want to Work

The Nanaimo Regional General Hospital in British Columbia, Canada, opened its expanded emergency department last year which has received rave reviews from patients and staff.

Front line staff met with the architects to discuss what type of building they would like and four key principles were established: confidentiality, timeliness of care, a light-filled environment and a place where people want to come to work.

“The design group has done an excellent job of bringing together this much-needed expansion for our emergency department, with innovative technologies and green building elements such as automated window shading, radiant panels, direct digital temperature control and other energy-saving features,” said Joe Stanhope, chair of the Nanaimo Regional Hospital District.

Don Hubbard, Vancouver Island Hospital Authority board chair noted the hospital is the busiest such building on Vancouver Island, seeing more than 57,000 patients per year.

“The new wing is highly efficient with streamlined processes to provide patients with a better experience,” he said. “The light-filled rooms, numerous windows, skylights, private isolation rooms and courtyards provide a calming setting for patients and their families.”

An exemplary example of functional emergency department design, Nanaimo will be a flagship for the area and used as inspiration for new or upgrading hospitals across Canada and the world.