East Tennessee Children's Hospital Emergency Department Renovation

Since 1937, East Tennessee Children’s Hospital (ETCH) has served as the region’s only pediatric hospital, providing care for children throughout the Southeast. The Emergency Department sees over 60,000 injured and sick children every year. To accommodate a growing pediatric care population, ETCH identified a need to renovate their existing Emergency Department to increase efficiency, improve patient flow, and update aging interior spaces. Located within Knoxville’s urban center, ETCH has little room to accommodate new construction projects. The only viable option for the improvement of the Emergency Department was an intensive, multi-phase renovation. The completed enhancements include dedicated trauma rooms, exam rooms with enhanced privacy features, sensory-sensitive rooms, behavioral health, a relocated ambulance bay, and separate patient intake and exit areas. The new lobby provides patients and families with ample daylight, access to exterior views, play areas, updated & comfortable seating options, a vibrant and engaging interior, and separate waiting for sick & well patients. The ED exterior updates the existing 1970’s brown brick façade and provides a clearly identifiable patient entry & drop-off. Throughout the planning process, members of the ETCH Family Advisory Council (parents of ETCH patients) provided input to help ensure a patient focused & family friendly design outcome. The largest challenge to the project was to successfully renovate the existing Emergency Department in-place while it continued to provide patient care during construction. The renovation was divided into 8 phases and involved the careful coordination of the general contractor, designers, and hospital staff.

Framework for Design Excellence

Design for integration
• Full scale mock-ups of an exam room, trauma room, and staff “core” work area were constructed for direct staff input on the headwall devices and to confirm the spatial layouts were adequate. These detailed mock-ups included equipment, accessories, and cabinet design to ensure sizes and shelving placement would accommodate all the supplies they need.
• Members from ETCH’s Family Advisory Council were also consulted throughout the design phase to give input on how to make sure families are comfortable in the space, primarily in the Waiting room which can typically be a high stress area. The members of this council are parents of ETCH patients who could give direct testimonials of their experiences.

Design for equitable communities
• Expanded ED allows it to serve a larger patient community, including behavioral health patients.
• ADA accessibility to entrance designed from both directions at street corner.
• Use of glazing and low walls at waiting room increases visibility between patients, public, and staff.

Design for water
• Entry ramp canopy system incorporates stormwater control that keeps sidewalk dry for pedestrian safety and waters planter beds along the ramps.

Design for economy
• Resilient flooring, wall protection materials, and cleanable furniture were selected to withstand high traffic and frequent cleanings in hospital environment. Epoxy flooring installed in waiting room for highest foot traffic.
• A more efficient exam room was laid out with decentralized staff work areas, separated staff and patient circulation, and additional triage rooms that allow staff to treat patients more efficiently, take fewer steps, and decrease wait times.
• In-wall nurse server cabinet and trash cabinets design allows access from staff core to help improve infection control and streamline restocking process.

Design for energy
• Incorporation of full-height glazing at waiting room allows for natural lighting, combined with exterior canopy to shade from the harshest glare and heat.

Design for well-being
• Partition acoustic design provides for patient privacy in exam rooms while glazing facing the staff work areas allows for staff visibility of patients as needed.
• Arrangement of low walls in waiting room creates pockets of seating and activity so that children may play while remaining visible to families.
• Provision of natural light in waiting room connects patients and staff to nature.


Design for resources
• Selection of resilient flooring, wall protection materials, and cleanable furniture that can all hold up to high traffic and frequent cleanings in hospital environment.
• Zero VOC gypsum wall paint products.
• Local materials and craft celebrated with local artist installations in waiting room.

Design for change
• Layout of trauma rooms and adjacent support spaces plans for an expansion to a third trauma room if required by population growth.
• At the waiting room, there are two distinct seating areas to provide separation between sick patients and well/injured patients. The spaces are designated with colors, to provide flexibility for staff to redesignate the areas depending on the needs of the season.
• Installation of modular furniture in place of built-in millwork allows for easy reuse in future renovations.