The demise of the waiting room as it exists today

Akshay Sangolli, AIA, ACHA, EDAC, LEED AP BD+C
Senior medical planner, managing principal-Denver,
EYP Architecture & Engineering

Health care facilities across the country are making dramatic changes to their waiting areas in response to the coronavirus pandemic, which has accelerated the growing belief that the very concept of a “waiting room” is long overdue for a critical reevaluation.

Currently, from hospitals to retail clinics, patients entering a health care environment are being treated with the assumption that they could be COVID-19-positive and adjustments to intake processes have been made accordingly. The Centers for Disease Control and Prevention recommend the implementation of “source control for everyone entering the facility, regardless of symptoms.” These changes start with the medical staff’s level of personal protective equipment, such as N95 masks, face shields and gowns, for all personnel interacting with visitors and patients. Many health facilities also are attempting, as much as possible, to maintain 6 feet of separation between visitors, and between provider and patient.

Mark Vaughan, AIA, FACHA
National director of medical planning, senior principal,
EYP Architecture & Engineering

Such “social distancing” modifications have extended to waiting rooms themselves, either by removing or reconfiguring seating areas. For nonemergency intake facilities, the increased use of appointments is helping to reduce crowding as well. Patients must also do their part by wearing masks before entering the facility and arriving unaccompanied.

Old carpets are replaced with other resilient floorings, deep cleanings occur regularly, hand sanitizer is everywhere and Plexiglas shields are being installed. Waiting rooms in the time of COVID- 19 are definitely areas in transition.

Why Wait?

Even before the pandemic, the medical community widely recognized the idea of a “waiting room” was in dire need of a rethink. Waiting is never enjoyable, especially if you are waiting in an area with other potentially sick and contagious patients. From an economic standpoint, a patient waiting is not contributing to a hospital’s bottom line and it is seldom a “value-added” experience for patients, who are often missing out on their own work and other obligations as they wait.

Most importantly, improved intake improves health outcomes. After all, getting the patient where he needs to be as quickly as possible, especially in emergency situations, is vital.

Intake trends already were headed in the right direction, including incorporating biophilic design in waiting areas and prioritizing quick and efficient intake and rooming.

But they still have a way to go. Overall, the average wait time to see a doctor in a taken before the pandemic was approximately 18 minutes, 13 seconds; as expected, longer waits negatively impacted patient satisfaction. For hospital emergency departments, normal wait times exceeded 90 minutes.

Pioneering facilities are beginning to completely rethink the process; several have created the position of “intake physician” as a point person to immediately assess incoming patients and assign them to the appropriate path of care. COVID- 19 may push health care facilities toward “just-in-time” delivery of care and a greater integration of technology.

A Future Relic

Revamped intake procedures go hand in hand with revamped spaces, and clearly the temporary modifications to the areas themselves must be made permanent in many respects.

Private waiting spaces – they might even be described as “pods” – are one possible step forward, because while patients must be socially distant from each other, the close companionship of a friend or family member who can advocate and convey patient needs, is often vital to health outcomes; it can truly save lives if the patient is incapacitated to some degree and is unable to fully describe their need themselves.

More broadly, patient intake needs to be staged in various zones of processing. Some facilities have even erected pre-entry tents amid the COVID-19 outbreak to screen for high temperatures before admitting persons into the building; making these phased entries permanent is likely for many facilities. In addition, because patients often arrive at a health care facility via their personal vehicle, having them waiting inside their vehicle also has been an option used during the pandemic that could become the norm.

Not every design trend requires a large capital expenditure either, as smarter use of technology also can greatly impact intake efficacy. As previously mentioned, wider use of online appointments can reduce crowding, and within the facility itself, text and/or mobile reminders allow patients to wait elsewhere rather than congregate in a centralized location.

Tech to the Rescue

Looking to the future, telehealth as a preemptive measure will help reduce crowding as well. Health professionals are seeing 50 to 175 times the number of patients via telehealth as before the pandemic, according to the American Medical Association, and nearly half of patients are using telehealth to replace at least one in-person visit, compared with 11% a year ago.

And telehealth doesn’t just mean between patient and doctor. To the extent the law allows, better sharing of patient health data between facilities will reduce the need for waiting areas by streamlining flows across the entire system. Just as ailments sometimes appear localized in a patient but are rather symptomatic of larger underlying drivers, the bottlenecks current waiting rooms experience are as much a factor of systemic design flaws as they are of the specific space itself.

The “waiting room” as it exists today may well become a relic in a post-COVID-19 world. Fortunately, health care professionals had already largely acknowledged that fact, but perhaps hadn’t yet realized how much improvement was needed.

Imagine getting a text at home when you would need to start driving for your appointment, checking in with an app from the parking lot, being immediately screened and triaged outside the building by a health professional, hitting a prompt on your smartphone to open a wayfinding map of your surroundings, walking to the appropriate entrance and going straight to your examination room which has been freshly sanitized for your arrival.

We must completely reevaluate not only the waiting area itself, but also the processes and protocols surrounding patient intake and the broader picture of how it fits within the system as a whole. In an on-demand world, waiting for care is no longer admissible.

Featured in the October issue of Health Care & Senior Properties Quarterly