A Systematic Review of Built Environment Interventions to Improve Patient and Staff Outcomes in Emergency Department Mental and Behavioral Healthcare

The built environment of Emergency Departments (EDs) provides the context and setting for care delivery, influences workflows, and shapes user interactions, but its noisy, sterile, stimulating nature can be counter-therapeutic to patients in psychiatric crises. As ED Mental and Behavioral Health (MBH) presentation rates rise, healthcare organizations and designers must develop strategies to address challenges and improve care. This systematic review analyzes emergency department-based built environment interventions implemented to improve the safety and experiences of patients seeking emergency MBH care and ED staff involved in their care. Our team searched six databases in March 2023 using PRISMA methods and the SEIPS 3.0 framework to identify and analyze nineteen studies of ED-based built environment interventions for MBH care. Interventions occurred at three scales - unit, room, and element - and impacted patient and staff outcomes. For example, MBH units located outside of the main ED contributed to decreases in length of stay, boarding, and inpatient psychiatric admissions. Room and element-scale interventions helped improve patient experiences and increase safety. This review summarizes existing knowledge surrounding built environment interventions for emergency MBH care and identifies opportunities for design and clinical practice applications. Future research is necessary to capture patient and staff voices, examine various types of EDs, and compare interventions across hospitals. This review shows how physical interventions in the built environment of EDs - from individual elements to entire units - can improve processes, safety, and experiences for MBH patients and staff, especially when incorporated into broader, systems-based changes.