New research conducted by Arsalan Gharaveis, Ph.D., AIA, NCARB, EDAC, a senior medical planner at California-based Taylor Design, and published in the Health Environments Research & Design journal, explores the relationship between visibility and security risks in emergency departments (EDs).

“Visibility is crucial to the architectural design and layout of these spaces,” Gharaveis explains. “We aimed to address this prominent issue raised by ED nurses, that [issue] being the challenge of tackling security concerns through enhanced visibility.”

Gharaveis and his colleagues studied EDs in six hospitals within the Houston Methodist health system in Texas. They interviewed 17 clinical staff members and spent 48 hours in field observations, examining varied layouts and the visibility they afforded.

One ED had a racetrack design with a central team station, divided into two low-visibility wings. Another featured a linear layout with three major workstations, while a third used pods for both medical and nonmedical staff. Another had two pods with unequal patient loads, and the final space consisted of a main area with nurse stations at each end, plus segregated trauma and fast-track areas.

“Each department was part of the same system and shared a corporate culture. We wanted to minimize variations in that area so we could focus on design elements,” Gharaveis says. 

The researchers confirmed visibility’s crucial role in staff risk response. Limited sightlines contributed to problematic events and escalation. Nurses in segregated fast-track areas struggled to alert others due to poor visibility. The study emphasized nurses’ vulnerability, given their more frequent patient interactions when compared to physicians. 

However, visibility is elevated when staff are more evenly distributed throughout the unit. This is particularly useful when staff at workstations need visual contact with colleagues and security officers during emergencies.