The Emergency Department Renovation began when Hamilton Health Sciences re-organized its operation, including the consolidation of all Pediatric Emergency Services at the McMaster University Medical Centre. This meant Hamilton General Hospital would pick up additional ED visits with a focus on Cardiac care. It had the capacity for 32 patient spaces and five designated overflow spaces located in the public corridor. This would not accommodate the 39 patient spaces required, which kicked off this exciting and intricate project.

Having been involved in the design concept drawings, the goal of this initial project was to find room for five additional beds in the CTAS 1 and CTAS 2 areas of the Hamilton General Hospital. The original vision involved moving the location of the fracture clinic and renovating this area together the four-bed cardiac area that existed in the original floor plan.

We worked closely with the staff, examining interior circulation from the perspective of patients, ambulance, staff, and the public, taking into consideration both entry access points and horizontal circulation routes. We engaged with physicians, nurses, diagnostic imaging, administration, and finance departments as we began to resolve our renovation approach.

In this stage of the project, we proposed a reorganization of interior spaces including:

• The rapid assessment zone which was fully renovated
• Immediate care, although much was left as is and the areas of renovation disparate from one another, recognizing that ED Phase 2 would follow to address those areas and requirements
• The resuscitation and trauma area which was fully reimagined

While improving privacy, the solutions would provide segregation of clean utility from soiled; relocated a staff room inside ED; and created a dedicated Fast Track area to treat minor cases. The reorganization served a dual purpose, addressing issues related to public surveillance and patient administration.

Construction phasing became one of the most interesting and unique challenges within this complex renovation, developed to ensure the Emergency Department would continue to function 24/7 throughout the renovation period. The sequence of work was organized in three stages, with a series of steps which helped to ensure minimal disruption in this critical care department.

• We successfully developed a complex and multi-phased project that allowed the emergency department to remain operational throughout the renovation process.
  
• We found a unique solution that allowed the facility to handle more patients should there be a large-scale emergency, with a flexible design for its bays that could accommodate more than one bed at a time if needed.
  

• Our team provided a successful, integrated design that carefully balances the diverse needs of the hospital's many stakeholders, including its function as a teaching hospital.