Trends in ED and Inpatient Services

In March, an interesting article was published examining the trends in the supply of beds in California’s emergency departments in relation to those in inpatient services. This retrospective analysis reviews the supply and demand of beds from 2005 – 2014. It addresses several factors contributing to the ebb and flow of bed availability across the state and presents a new methodology for analyzing trends. The new metric – ‘beds per visit’ –  suggests the State of California has an inadequate supply of ED and specific inpatient beds.

While this study looks only at the State of California, the issue of ED overcrowding continues to plague hospitals across the United States. We are interested in better understanding this phenomenon and how the hospitals in which we work strive to manage this symbiotic relationship between emergency departments and inpatient services.

Build for Humanity

An independent affiliate of Habitat for Humanity International, Habitat NYC has worked since 1984 “toward a world where everyone has a decent place to live.” Their mission is to ensure that every New Yorker has a decent, affordable home.”

“Build for Unity” is HABITAT for HUMANITY’s way to bring attention to our country’s growing cultural intolerance and discrimination. Last weekend, many nationalities, faiths, ethnicities and ages, worked side by side to help in the construction of 15 affordable housing units for low-income families to own. It demonstrated that we can all work together altruistically to achieve positive change for the lives of others.

It is an excellent opportunity to do for others while gaining useful construction experience in route to understanding about constructability (what’s easily built from the details we draw). It is rewarding in so many ways and I recommend it for everyone especially our junior designers and detailers. There are few weekends, better spent.

Go Red for Women

Happy Go Red for Women day! Today we show our support for women struggling with and affected by heart disease and stroke.

Did you know heart disease is the No. 1 killer of women, causing 1 in 3 deaths each year? That’s approximately one woman every minute.

Here are a few more facts to keep you in the know: 

  • An estimated 44 million women in the U.S. are affected by cardiovascular diseases.
  • 90% of women have one or more risk factors for heart disease or stroke.
  • Women have a higher lifetime risk of stroke than men.
  • 80% of heart disease and stroke events may be prevented by lifestyle changes and education
  • Fewer women than men survive their first heart attack.
  • The symptoms of heart attack can be different in women vs. men and are often misunderstood – even by some professionals.

Learn more about the warning signs of heart disease and stroke here.

Cancer Death Rates Fall


E4H was elated to read the number of deaths from cancer in the United States have dropped 25 percent since hitting a peak in 1991. The report, issued by the American Cancer Society, hit home for a lot of us.

This drop means that 2.1 million fewer people died from cancer between 1991 and 2014 than would have died if cancer death rates had remained at their 1991 level, the researchers said. As mothers, fathers, sisters, brothers and children, we appreciate what a big deal this is for families across the world.

The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer’s deadly toll,” Dr. Otis Brawley, the chief medical officer of the American Cancer Society, said in a statement. “Continuing that success will require more clinical and basic research to improve early detection and treatment, as well as strategies to increase healthy behaviors nationwide.”

We are proud of our work with both healthcare providers and researchers who work to fight the many forms of this disease.

This story was originally reported in LiveScience


Policies on Aging

Gables at East Mountain
Gables at East Mountain

An interesting article on Elder Rights in China was published in this month’s issue of The Journal of The American Medical Association (JAMA) Internal Medicine. Author XinQi Dong, MD, MPH outlined the policies being enacted by the Chinese government to combat changing demographics and cultural expectations for filial duty.

Historically, Chinese families have seen filial piety as the highest of virtues in accordance with the treatise Classic of Filial Piety outlined by Confucius in the 4th century BC. However, these beliefs are being challenged by the Chinese people. In a recent survey by the Center for Strategic and International Studies on East Asian retirement practices only 4% of Chinese respondents believed children or family members should be responsible for proving support to older adults – the lowest percentage of all six Asian countries surveyed.

Although the One Child Policy restricting family size from 1980 to 2015 was repealed, the unintended consequence to demographics is palpable for many young workers. The realities of one working adult expected to support four grandparents and two parents are often overwhelming. Additionally, with the increase of industry around the country, many younger people are moving away from their homesteads in search of economic opportunity.

The disconnection between historical familial expectations and existing practices has forced the Chinese government to look for policy solutions to protect and support its 123 million residents (9% of the population) over 65.  In May of 2016 the Shanghai Ministry of Civil Affairs Bureau, a governmental agency ruling the largest city in China, implemented a new policy to protect older adults and shame children into supporting their families. Children found to lack devotion to their parents are placed on a ‘credit blacklist’, a tool used by the government to prevent individuals from activities such as opening a bank account, purchasing a home, or starting a business.

Dr. Dong, a professor at The Rush University Medical Center Institute for Healthy Aging, brings up an interesting and sensitive topic for many people across the globe – how do we care for our aging family members?

It is an honor to be a part of these discussions within our communities as we design senior living facilities that address the holistic needs of residents, their families and the community. Although we are far from any universal solution, it is encouraging to participate in the ongoing dialogue regarding aging with dignity and care.

E4H Project at Memorial Sloan Kettering Highlighted in Vice President Biden’s “Moonshot” Cancer Initiative


E4H designs space for Epigenetics Program at Memorial Sloan Kettering. Over the years, E4H has worked extensively to transform the facilities across the Memorial Sloan Kettering health system, including an improved ICU, upgraded outpatient exam Rooms, a wellness-focused rehabilitation center,  and the freestanding Sidney Kimmel Center for Prostate & Urologic Cancers.

A full renovation of the 4th Floor of Memorial Sloan Kettering Cancer Center created a space for the new Epigenetics Program, where scientists and clinicians can engage in scientific discovery, translational cancer research and drug development. The aim is to facilitate faster discovery of breakthrough therapies by bringing scientific research closer to the point of care.

The renovations of this world-renowned medical center were designed to propel its cutting-edge research. E4H Architecture’s New York office led this multi-year phased project, which incorporated our Smart Facility Design principles to best support current evidence-based clinical practices, for patients, clinicians, and staff alike.

The next phase in development will renovate the building’s walkways and existing laboratories to provide more space to accommodate contemporary models of interdisciplinary care teams. The offices from the 2nd through 10th floors are being redesigned and converted into interactive areas for collaboration, and conference rooms will be upgraded to include state-of-the-art communications technologies.

In May, Vice President Joe Biden visited the Epigenetic Center at Memorial Sloan Kettering Cancer Center in New York City as part of his “moonshot” initiative to cure cancer. Over the last several months the Vice President has met with hundreds of top cancer physicians, researchers, and funders to show the federal government’s commitment to increasing public and private resources in the fight against cancer. The Vice President has also called on the medical research community to share data and information in order to accelerate our understanding of the disease, its causes, and options for a cure.

Take 5 with Dan Morris

D Morris

Dan Morris, founding partner of Environments for Health was recently asked to contribute to the Healthcare Design series, Take Five. In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject. Below is the full article, originally published by Healthcare Design.

Dan Morris is founder and managing partner of MorrisSwitzer Environments for Health, which recently merged with Ascension Group Architects and DaSilva Architects to form E4H. Here, Morris shares his thoughts on ED design, the monetary benefits of private patient rooms, and future advancements for materials in healthcare facilities.

1. Privacy, please  

We all know that private patient rooms have a host of benefits, including reduced incidents of healthcare-associated infections (HAIs), patient falls, and patient transfer and medical errors, and each one of these is a potential cost-savings driver. But what about the potential business case that can be made for private rooms not only saving money but actually paying for themselves? Through our firm research, we’ve found that does in fact appear to be true and that the cost savings achieved by converting to private rooms can actually cover the debt service on renovation costs. The question hospitals may have to consider is not whether they can afford to do it but rather can they afford not to.

2. It’s on the surface

We’re on the cusp of a material and technological shift that may largely do away with contaminated surfaces that harbor and transmit bacteria that can lead to HAIs. On the material side, there are biomorphic-inspired surfaces that make it hard for bacteria to attach to a surface. Copper used for high-touch surfaces and copper-infused materials also have excellent bacteria-fighting characteristics. Technological breakthroughs are also on the way in the form of light fixtures that can continuously kill bacteria on surfaces and in the air. It’s an exciting time to be a healthcare design professional, knowing the impact our work will have in making hospitals a truly healing environment.

3. Patient satisfaction shaping ED design

The last place anyone wants to spend time in is the ED waiting room. After all, the reason you’re there is because you thought you had an emergency and waiting for service greatly affects your perceived satisfaction of the medical encounter. Many hospitals are actively expanding their EDs in an effort to accommodate higher throughput, but that extra space needs to be well thought-out to support timely, patient-center care. Separate entrances for walk-ins and ambulance arrival to facilitate triage, testing, and treatment, layouts that adjust to changes in patient volume over a 24-hour cycle, and rapid triage and treatment areas for low-acuity patients are just some of the ideas being implemented.

4. Building a better medical home

What constitutes the perfect setting for the medical home model? There probably isn’t a pat answer, but for us it’s about giving as much attention to designing spaces for collaboration as we do for patient interaction. It’s also about flexibility and making sure that adjacent clinics aren’t so specialized that they can share spaces easily with each other throughout the day. Finally, it’s about designing those aspects into an environment that’s welcoming, soothing, and nonthreatening for the patient so that they can feel comfortable, such as organic colors and textures, comfortable furniture, and natural light.

5. Energy efficiency as a design driver

Hospitals are among the biggest energy consumers in the U.S. According to a report for the U.S. Energy Information Administration large hospitals account for less than 2 percent of all commercial floor space but consume 5.5 percent of the energy used by the commercial sector. Well-designed healthcare facilities can support new care models, energize staff, provide flexibility, and promote health while also being environmentally and operationally sustainable. According to recent reports nearly 2,200 healthcare construction projects have received LEED certification or are seeking it. Healthcare design can help lead the way in reducing energy consumption.

EMMC featured by Healthcare Design


Thank you to Healthcare Design for highlighting Environments for Health’s work at Eastern Maine Medical Center (EMMC)! Read the full article here.


EMMC has been a tremendous, long-term client of ours having worked with them on this project from master plan through implementation.

We were proud to see phase 1 open, bringing improved care to the patients and more efficient facilities for the staff. We have a great team continuing phase 2 of the project in Bangor – keep up the good work!

How Tall Buildings Touch The Sky


Yesterday afternoon, in a quiet moment as I was staring out of my office window in midtown south, I was thinking about the skyline and how tall buildings touch the sky. Louis Sullivan theorized that the skyscraper (the new building form in his time) should be designed like a column, with a distinct base, shaft and top or capital. If you look at many late 19th century buildings in NYC, this directive seems to have been widely adopted.

Other architects, at the same time, took this in another direction. Drawing inspiration from Gothic architecture, they seemed to think that tall buildings should pile up and up in ever narrowing masses, culminating in points like those of the spires of a cathedral reaching toward heaven. All around us are examples of this design thinking. Then there are the modernist boxes, which disregard all of this previous thinking, and replace it with geometric repetition, sometimes with vertical elements to emphasis the height and sometimes with horizontal banding which often ignores both height and scale, piled repetitiously one of top of the other.

From my office I can see examples of all of these schools of thought as well as other idiosyncratic buildings, which seem to adhere to no particular theory. I see Raymond Hood’s Radiator Building on Bryant Park (peeking up out of anonymous masonry masses) ending in vertical spires, masonry buttresses and arched windows, gilded and glistening in the sunlight, piling up around an octagonal element (does it enclose a water tower?) spilling out white streams of smoke or steam into the blue sky around. Directly behind it is the WR Grace Building, an SOM geometric box, which rises in horizontal concrete and black glass bands to a banal flat band. Down the street, 200 Fifth Avenue grows in multiple masonry increments pushing itself in vertical limestone and brick ribbons upwards to a lovely pinnacle, which unfortunately is now held in place, silver boxes of air handling units. Peaking through a slot between fussy repetitive orange brick 1970s boxes is the glory of the Chrysler Building, shining in silvery arches pushing back into itself through to its iconic needlepoint. This building does not so much scrape the sky as inoculate it with Deco cadmium splendor. Lower down, squatting on top of multiple receding piles of masonry are those wooden barrels, variously hued, NYC water towers.

What a composition this cityscape is, so full of diversity and complexity, reflecting the imaginations and hubris of various ages, reaching upwards and upwards as if after some constantly receding prize in the sky! What a joy to look out upon it and to live and work in it.

Author: Jaques Black