Focus: Facility Design

Ligature resistant door solutions for multi-use healthcare facilities

By Siva Davuluri / Special to Healthcare Facilities Today
June 22, 2020

Healthcare providers across America have dealt with a sharp rise in behavioral health-related patients in recent years. The National Alliance on Mental Illness (NAMI) said that mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult. This translates to an estimated 12 million visits per year. 

NAMI also reported that mood disorders are now the most common cause of hospitalization for all people in the U.S. under age 45. Since many emergency rooms and hospital rooms are not built for this number of behavioral health patients, there is a lack of resources for treating patients in a safe and secure environment. 

Hospitals, urgent cares and other healthcare facilities face a number of challenges when treating patients. From overcrowded emergency departments to limited resources and staff, thousands of facilities are working over capacity. This reality becomes even more challenging when patients with serious mental illness need emergency treatment and seek help at facilities without anti-ligature safe examination rooms. While doctors and nurses are tasked with treating patients, specifiers also have a responsibility to develop interchangeable spaces that meet the demands of multi-use healthcare facilities.

Designing for flexibility and increasing safety

Patients that are determined to be at risk for self-harm (or could potentially harm others), who are admitted to non-behavioral health settings must be protected. Exam rooms must be assessed for items such as breakable glass, non-ground fault protected electrical outlets, sharp items, chemicals, alcohol-based hand gel, and ligature points.

In non-behavioral health facilities where it is impossible to remove all ligature risks, additional safety measures must be taken. In these cases, CMS does not consider standard 15-minute checks to be an appropriate safety measure for patients at risk for harm to self. If patients are determined to be at risk for self-harm and all risks cannot be removed, they must have continuous 1:1 monitoring. This practice is an expensive proposition and can put staff and volunteers in dangerous positions. 

For cash-strapped healthcare systems and independent facilities alike, these challenges are overwhelming. So how can a facility create a multi-purpose space that can treat a wide variety of patients, including those that present with self-injurious behavior? How can urgent cares, hospitals and long-term care facilities afford to do this when their exam rooms are already at capacity and there is no budget for a separate behavioral health wing? The answer is to create an environment that can easily be transitioned from a regular room to a space that is free from ligature points. 

In order to assist specifiers in creating flexible treatment spaces, rolling door manufacturers have devised new ways to turn standard exam or emergency care rooms into behavioral health-friendly spaces. Advanced new ligature-resistant counter doors deploy with the press of a button – securing medical equipment, cabinetry and other potential ligature points that can be used for self-harm or against staff and medical providers.

Reasons to specify ligature-resistant counter doors

In order to create these transitional treatment spaces, rolling door manufacturers have designed advanced ligature-resistant doors that cover cabinetry, countertops, computers, medical equipment and other items with a single rolling steel door. 

By placing the fascia side motor above the ceiling and the coil above the medical cabinet, designers can create a completely flat surface facing the patient's room to cover sinks, cabinets, access to oxygen tanks, and other potentially dangerous equipment. In addition, all fasteners are concealed, and the bottom bar is flat, eliminating potential ligature points.

Some products also feature a “constant pressure to close” system that is mounted on the wall outside of the patient room. “By placing the operator outside of the room, staff are able to watch the door go up or down without being in the space,” said Nicole Vivalda, product manager, CornellCookson. This provides the best level of security for both the patient and provider. 

“The facility can ensure the door is closed and ligature points are removed with a visual inspection,” said Vivalda. “Plus, it prevents the staff or a healthcare provider from being in a compromising position (back turned, crouched down) while locking, unlocking or even operating the door manually from within the room.” 

“The doors are designed to be impact, tamper and ligature resistant as well,” she said. “There are no exposed fasteners, grab points or pinch points and our products meet ASHRAE/Facility Guidelines Institute (FGI) recommendations for exam rooms.”

To prevent damage from patient impact, counter doors can be specified with wind loaded guides. Many exam room counter doors can be designed to blend in or complement existing rooms with design options available in stainless steel or galvanized steel with powder coat. 

When paired with ligature-resistant door knobs, ceiling systems and furniture, these doors create multi-purpose exam rooms that can be used for evaluating a wide variety of patients. If there is an increase of patients with behavioral health needs, the doors can be easily deployed. 

Beyond patient and staff safety, Vivalda also stressed the monetary benefit of ligature-resistant counter doors. “These products are an easy solution to a very serious problem and prevent hospitals from having to build a separate wing for mental and behavioral health patients. Exam rooms can be easily transitioned back and forth with the touch of a button. It doesn’t get much easier than that.”

By specifying ligature-resistant products hospitals, long term care, urgent care and other institutional facilities to utilize the same exam room for both medical and behavioral health patients back to back. And when that patient load diminishes, the doors can be retracted, converting back into standard examination rooms. Creating a multi-purpose rooms like these saves the healthcare provider money and resources while providing much needed security for patients and healthcare providers.

Turn to a professional

Just as patients turn to their trusted medical providers for help, it’s important that specifiers working in healthcare facilities turn to manufacturers for product recommendations and specific design and installation questions. Product experts have spent years working on solutions to behavioral and mental healthcare challenges in the building environment, and they are ready and willing to help you save money and time by creating multi-purpose exam rooms. 

Siva Davuluri serves as vice president of marketing at CornellCookson Inc.

 

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