Design Considerations and

Summary of Evidence:
childrens emergency, inpatient
and ambulatory health services

Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 1 of 8

Introduction.............................................................................................................3
Consideration 1: family centred approach to service delivery...............................3
Consideration 2: workflow and separations ..........................................................3
Consideration 3: privacy & acoustic control ..........................................................4
Consideration 5: child and family friendly environment and provision of
entertainment ........................................................................................................4
Consideration 6: furniture, fittings, equipment and ambience...............................4
Consideration 7: ergonomics & safety ..................................................................5
Consideration 8: space requirements ...................................................................5
Consideration 9: signage and wayfinding .............................................................5
Consideration 10: parking & access .....................................................................6
Examples of paediatric facility design: ..................................................................6
Reference list: ..8

Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 2 of 8

Introduction
This document is a summary of current evidence regarding design considerations,
relating to the physical, visual and auditory environment for childrens emergency,
inpatient and ambulatory health services. This includes considerations for co-located
childrens and adults services, and mixed emergency services.
An opportunity exists to apply past learnings and current evidence to enhance future
health service planning, design and the provision of services. The following evidence
has been identified from an investigation of literature and stakeholder input specific
and unique to the paediatric built environment and health service context.
The information contained within this document provides overarching direction that
aims to address the environmental needs of children and their families in the
planning, development and provision of childrens health services. It may need to be
updated as more information becomes available. Project teams need to be aware
that this material was collected at a point in time and will need to be supplemented
with any new evidence and with reference to current policy, standards and
guidelines.

Consideration 1: family centred approach to service delivery

An integrated and coordinated approach considering the child, their particular needs
and the needs of their family are core to this concept. Information sharing between
staff, child and family allow understanding and education of the illness or injury and
encourage active participation in making decisions about their health and care. This
empowerment and collaboration also facilitates the ability to exercise choice and
improves and enhances clinical outcomes for children. The approach applied and
supported by design should be respectful of family diversity and responsive to
priorities and choices made by families [14, 18, 19, 26, 30].

Consideration 2: workflow and separations

Separating the childrens entrance to emergency services, in addition to separating
the childrens triage area, waiting area, acute treatment spaces, inpatient and
ambulatory areas will ensure minimal visual and auditory contact with adult patients.
This will reduce the risk of child exposure to a potentially negative experience.
Equally, this separation will minimise the disturbance of adult patients by distressed
or disturbed children [12,15,16,20, 28] (refer to Consideration 4: visibility).
Where separate adolescent wards are not available, flexible alternative solutions may
be considered such as grouping adolescents together in a childrens or adult ward
with an adolescent recreation space or activities area relevant to adolescents.
Isolation rooms should be provided for the treatment of potentially infectious patients
[4, 26]. The type and number of rooms will be determined by current policy,
standards, guidelines and a review of individual facility requirements. In an
emergency department, these rooms should be in close proximity to triage to allow
for immediate isolation of potentially highly infectious patients [2].

Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 3 of 8

Consideration 3: privacy and acoustic control

There is evidence that increased noise levels may increase levels of environmental
stress for consumers and staff. Sound control should be designed to minimise
transmission of noise between adjacent treatment areas and designated sound
attenuated treatment rooms provided for procedures. Ceiling acoustic tiles,
absorbent panels, walls, curtains, upholstered furniture and carpets can be used to
absorb and soften sounds to provide a less stressful environment for children and
their family [3].
Single occupancy rooms provide privacy, isolation capability, as well as capacity for
parent live-in (eg. fold-out bed or recliner chair). A high proportion of single bed
rooms may need to be balanced with break out areas to provide opportunities for
socialisation in settings where appropriate (refer to Consideration 4 & 5).

Consideration 4: visibility
Clear visual contact provides staff with optimal observation of all patient areas,
including waiting areas and play areas, and outpatient, bed and treatment spaces.
Nursing staff must be able to oversee or supervise the patients at all times, which in
turn allows the child and their family to feel safe and reassured. However, there must
be a balance between supervision and the need to protect the privacy and personal
dignity of the patients and their family [3] (refer to Consideration 3).
In an emergency service the triage nurse should have good visual contact between
the triage area and the childrens waiting area to allow for monitoring of change in
patients condition whilst waiting to be assessed by a medical officer.

Consideration 5: child & family friendly environment and provision of

play/entertainment
Provision of suitable entertainment areas and play facilities in and around the
childrens ambulatory and acute services will facilitate a welcoming and comfortable
environment for the patients and family. It will also provide the parent/carer close
proximity to the appropriate nurse, separate waiting and lounge areas and
beverage/food amenities. While opportunities for socialisation and play require
consideration, this should also be balanced with opportunities for solitude and safety
(refer to Consideration 3 & 7).
Outdoor areas specific for children will provide areas for safe play, recreation,
remedial activities and family visiting [1,9,16,20].
Zoning of the emergency waiting room should be considered in regards to infection
control, with segregated, family, small group and entertainment areas included [2].
Provisions of areas for play and socialisation need to be planned with consideration
of context and infection control issues. For example, provision of opportunities for
child socialisation may not be considered appropriate in high acuity areas such as an
emergency department.

Consideration 6: furniture, fittings, equipment and ambience

Age appropriate dcor, furniture and artwork will aid in patient distraction while
providing a comfortable and reassuring environment for the patient and their family.
Durable and cleanable materials used for furniture and fittings will assist to manage
the impact of wear and tear which may be higher in this setting.
Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 4 of 8

The therapeutic effects of viewing nature and gardens are well documented to
support optimisation of a healing environment. Windows providing an external and
pleasant outlook should be included in areas likely to be occupied for any length of
time by patients, family/carer or staff.
A parents room, baby change facilities and toilets for patients and family/carers
should be in close proximity to the childrens service areas and preferentially
separate from adult services waiting area.
The need for toilet/change facilities for older disabled children may need to be
considered as standard baby change and adult toilets may not provide a suitable nor
safe amenity for these children.
[1,6,8,9,11,17,19,20,27,33].

Consideration 7: ergonomics and safety

Age and scale appropriate design need to support safety, functionality and visibility of
features.
Furniture and fixtures should be designed and selected to anticipate the various
needs and demands of each context. For example, bench heights in public areas will
need to be considerate of requirements needed for a range of user groups such as
adults, children and wheelchair users of all ages.
Hazards should be minismised as much as possible by utilising rounded edges on
furniture at low levels, safety glass, barriers, balustrades and low vision door panels.
Other considerations include appropriate location or restricted access to
power/service outlets, alarms, handles and window heights should all be designed to
address physical, safety and security measures for safe guarding children [3].
Strategies to restrict access to staff areas or areas unsafe for children will also need
to be considered. For example, staff base and clinical procedure areas should be
inaccessible to children and their families when a staff member is not present.
Safety will also need to include design considerations for absconding, abduction and
issues surrounding family custody circumstances.

Consideration 8: space requirements

Childrens clinical requirements need to consider additional space to accommodate
facilities for the family/carer, such as chairs at bedsides, bed/recliners, kitchenette,
shower and toilet amenities (with stroller access) and baby changing facilities.
The provision of additional storage areas for age appropriate toys and ambulation
equipment in the acute clinical areas should also be considered. The design of
consulting and treatment areas must permit parents to remain with their child
[21,5,29,32,33].

Consideration 9: signage and wayfinding

Wayfinding is the process individuals use to navigate in unfamiliar surroundings.
Wayfinding extends beyond signage to include elements of site design, site layout,
physical, sensory, cultural and cognitive needs. The strategy implemented in a facility
should be consistent and appropriate for the childrens services context as well as a
Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 5 of 8

diverse range of facility visitors and users with differing levels of capacity and ability
to engage with the built environment.
The use of graphic and character display is encouraged, keeping in mind all age
groups of children, as different age groups each have their own visual prompts which
they are drawn to. Techniques must also be considerate of children and adolescents
who have learning impairments. [2,4,5].

Consideration 10: parking and access

Parking should be provided under or within close range of the emergency department
and include both disabled and parents with prams parking bays. The car park should
be well lit and protected from the elements and monitored by security personnel or
cameras [3].
Mixed (children/adults) emergency services should be on the ground floor for ease of
access. They should be close to public transport and adequately signed to ensure
ease of wayfinding (refer to Consideration 9).

Examples of paediatric facility design:

Texas Childrens Hospital, Houston, Texas

http://www.texaschildrens.org/
[4]

The Childrens Hospital of Montefiore, Bronx, New York http://www.montekids.org/

[10]

The Childrens Hospital at Westmead, Westmead, New South Wales http://www.chw.edu.au/

[21]

The Royal Childrens Hospital, Melbourne, Victoria http://www.rch.org.au/rch/index.cfm?doc_id=1495

[31]

Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC)

[10]

Flinders Medical Centre

[5]

Evelina Children's Hospital

[27]

Luke Waites Child Development Center, Dallas

[22]

Bloorview Kids Rehab, Toronto, Canada

http://www.bloorview.ca/about/index.php

Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

Page 6 of 8

Reference list
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(ACEM), Policy on hospital emergency department services for children
http://www.acem.org.au/media/policies_and_guidelines/P11_Hosp_ED_Services
_for_Children.pdf; 1-5.
2. Australasian College of Emergency Medicine (ACEM), Guidelines on emergency
department design
http://www.acem.org.au/media/policies_and_guidelines/G15_ED_Design.pdf, 125.
3. Australasian Health Facility Guidelines.
http://www.healthfacilityguidelines.com.au.
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Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

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17. How can you keep your young ER patients calm? Staff-originated pediatric
space entertains kids. Patient-Focused Care & Satisfaction 1999; 7(12): 140141.
18. Judkins S, Paediatric Emergency department design: Does it affect staff, patient
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19. Kesler CJ, Redesign of a paediatric hospitals triage and registration area.
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20. "Kid-friendly waiting areas in ED boost satisfaction: video games, bright colors
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21. Lanoix, R. and J. Golden, The facilitated pediatric resuscitation room. Journal
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22. Luke Waites child development center, Texas Scottish Rite Hospital for Children,
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centred care: What does it really mean?
http://qch.health.qld.gov.au/sections/1/Resources/family_centred_care.pdf
26. Queensland Health Electronic Publishing Service (QHEPS), Part D Infection
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http://qheps.health.qld.gov.au/capital_works/pdf/guidelines/ahfg_infec_control.pdf
27. Reid R, A healing place. Civil Engineering Feb 2006; 76 (2); 34-86.
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Children and Adolescents in Health Services 2008.
http://www.racp.edu.au/page/child-adol: 5-7.
29. Saba, J. L. and P. L. Bardwell. Universal design concepts in the emergency
department. Journal of Ambulatory Care Management 2004. 27(3): 224-236.
30. Schneider, Jay W, Family friendly childrens hospitals. Building Design &
Construction Feb 2009. 50 (2), 8, 24-32.
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33. Weinstein CS, Thomas D, Spaces for children: the built environment and child
development. Plenum Press 1987; Ch 6; 131-136.

Design Considerations and Summary of Evidence: childrens emergency, inpatient and ambulatory health services
Integrated Systems & Process Improvement Unit, PPAS
Health Planning & Infrastructure Division
Version 1.1
Endorsed HIPEC August 2010

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