The impact of crowds on visibility in emergency department: Integrating agent-based simulation and space syntax analysis

Abstract

Emergency departments (EDs) are among the busiest hospital units, where visibility is crucial for surveillance, collaboration, and wayfinding. In China, high ED patient volumes lead to crowded corridors, significantly impacting visibility. However, current visibility assessment methods focus on static obstructions such as walls and columns, neglecting crowd obstruction, and underestimating visual impediments.To address this research gap, this study proposes a novel visibility assessment method combining agent-based simulation and space syntax analysis. Based on peak-hour behavioral data from Hospital R's ED, crowd movement was simulated across six ED plans with different corridor layouts. The simulated crowd positions were then treated as visual obstacles, and space syntax theory was applied to evaluate visibility under crowd obstruction at various timesteps. The findings reveal that: 1) ring corridor layouts reduce patient backtracking and corridor congestion; 2) ring corridor layouts facilitate better natural surveillance of the overall space by medical staff with crowd obstruction considered; 3) ring corridor layouts enable medical staff to see each other more easily, supporting team collaboration, regardless of crowd obstruction; 4) simple layouts perform best in terms of wayfinding, irrespective of crowd obstruction. This study presents the first comprehensive quantitative assessment of ED visibility under crowd obstruction, with potential applications in other crowded public spaces.

Keywords

Emergency departments / Agent-based simulation / Space syntax / Visibility assessment / Crowd obstruction

References

[1] Ahmadpour, S. , Bayramzadeh, S. , Aghaei, P. , 2021. Efficiency and teamwork in emergency departments:perception of staff on design interventions. HERD 14 (4), 310- 323.

[2] Amaniyan, S. , Faldaas, B.O. , Logan, P.A. , Vaismoradi, M. , 2020. Learning from patient safety incidents in the emergency department:a systematic review. J. Emerg. Med. 58 (2), 234- 244.

[3] Benedikt, M.L. , 1979. To take hold of space:isovists and isovist fields. Environ. Plann. Plann. Des. 6 (1), 47- 65.

[4] Bennett, C.R. , Bex, P.J. , Merabet, L.B. , 2021. Assessing visual search performance using a novel dynamic naturalistic scene. J. Vis. 21 (1), 5.

[5] Cai, H. , Jia, J. , 2019. Using discrete event simulation (DES) to support performance-driven healthcare design. HERD 12 (3), 89- 106.

[6] Darraj, A. , Hudays, A. , Hazazi, A. , Hobani, A. , Alghamdi, A. , 2023. The association between emergency department overcrowding and delay in treatment:a systematic review. Healthcare 11 (3). Article 3.

[7] Dijkstra, E.W. , 1959. A note on two problems in Connexion with graphs. Numer. Math. 1, 269- 271.

[8] Esposito, D. , Santoro, S. , Camarda, D. , 2020. Agent-based analysis of urban spaces using space syntax and spatial cognition approaches:a case study in bari, Italy. Sustainability 12 (11). Article 11.

[9] Filingeri, V. , Eason, K. , Waterson, P. , Haslam, R. , 2017. Factors influencing experience in crowds — the participant perspective. Appl. Ergon. 59, 431- 441.

[10] Gharaveis, A. , Hamilton, D.K. , Pati, D. , Shepley, M. , 2018. The impact of visibility on teamwork, collaborative communication, and security in emergency departments:an exploratory study. HERD:Health Environments Research & Design Journal 11 (4), 37- 49.

[11] Gharaveis, A , Hamilton, DK , Pati, D , Shepley, MM , Rodiek, S , McCall, D , 2024. How Visibility May Reduce Security Issues in Community Hospitals' Emergency Departments. HERD:Health Environments Research & Design Journal 17 (1), 135- 147.

[12] Gharaveis, A. , Pati, D. , Hamilton, D.K. , Shepley, M. , Rodiek, S. , Najarian, M. , 2020a. The correlation between visibility and medical staff collaborative communication in emergency departments. HERD 13 (4), 81- 97.

[13] Gharaveis, A. , Pati, D. , Hamilton, D.K. , Shepley, M. , Rodiek, S. , Najarian, M. , 2020b. The influence of visibility on medical teamwork in emergency departments:a mixed-methods study. HERD 13 (2), 218- 233.

[14] Gharaveis, A. , Shepley, M.M. , Hamilton, K. , Pati, D. , Rodiek, S. , 2019. The influence of visibility on staff face-to-face communication and efficiency in emergency departments. Facilities 37(5/6), 352- 363.

[15] Guinther, L. , Carll-White, A. , Real, K. , 2014. One size does not fit all:a diagnostic post-occupancy evaluation model for an emergency department. HERD 7 (3), 15- 37.

[16] Guo, W. , He, Y. , 2022. Julie zook. Buildings 12 (9). Article 9.

[17] Hadi, K. , Zimring, C. , 2016. Design to improve visibility:impact of corridor width and unit shape. HERD 9 (4), 35- 49.

[18] Haghpanah, F. , Ghobadi, K. , Schafer, B.W. , 2021. Multi-hazard hospital evacuation planning during disease outbreaks using agent-based modeling. Int. J. Disaster Risk Reduct.:IJDRR 66, 102632.

[19] Haq, S. , 2019. Where we walk is what we see:foundational concepts and analytical techniques of space syntax. HERD:Health Environments Research & Design Journal 12 (1), 11- 25.

[20] Hillier, B. , Hanson, J. , 1984. The Social Logic of Space. Cambridge University Press.

[21] Improta, G. , Majolo, M. , Raiola, E. , Russo, G. , Longo, G. , Triassi, M. , 2022. A case study to investigate the impact of overcrowding indices in emergency departments. BMC Emerg. Med. 22 (1), 143.

[22] Istiani, N.F.F. , Alkadri, M.F. , Nes, A. , van, Susanto, D. , 2023. Investigating the spatial network of playgrounds during covid-19 based on a space syntax analysis case study: 10 playgrounds in Delft, The Netherlands. Cogent Social Sciences 9 (1), 216- 3754.

[23] Jiang, S. , Verderber, S. , 2017. On the planning and design of hospital circulation zones. HERD 10 (2), 124- 146.

[24] Li, B. , Fitzgerald, J. , Schultz, C. , 2022. Modelling the impacts of crowds on occupants in the built environment—a static, rulebased approach to human perception and movement. Adv. Eng. Inform. 51 (101452).

[25] Liddicoat, S. , 2019. Designing a supportive emergency department environment for people with self harm and suicidal ideation:a scoping review. Australasian Emergency Care 22 (3), 139- 148.

[26] Lim, L. , Kim, M. , Zimring, C.M. , 2019. Measuring interpersonal visual relationships in healthcare facilities:the agent visibility model and SAVisualPower tool. HERD 12 (4), 203- 216.

[27] Lim, L. , Zimring, C.M. , 2020. A conceptual visibility framework for linking spatial metrics with experience and organizational outcomes. HERD:Health Environments Research & Design Journal 13 (4), 225- 239.

[28] Liu, Y. , Zhou, Y. , Yang, L. , Xin, Y. , 2024. Simulating staff activities in healthcare environments:an empirical multi-agent modeling approach. J. Build. Eng. 84, 108580.

[29] Lu, Y. , Zimring, C. , 2012. Can intensive care staff see their patients? An improved visibility analysis methodology. Environ. Behav. 44 (6), 861- 876.

[30] Macal, C.M. , 2016. Everything you need to know about agent-based modelling and simulation. J. Simulat. 10 (2), 144- 156.

[31] Mediaworks . (n.d.).Crowd Simulation Software|Massmotion. Oasys. Retrieved October 14, 2022, from https://www.oasyssoftware.com/products/massmotion/.

[32] MohammadiGorji, S. , Bosch, S.J. , Valipoor, S. , De Portu, G. , 2021. Investigating the impact of healthcare environmental design on staff security:a systematic review. HERD 14 (1), 251- 272.

[33] Morgareidge, D. , Cai, H. , Jia, J. , 2014. Performance-driven design with the support of digital tools:applying discrete event simulation and space syntax on the design of the emergency department. Frontiers of Architectural Research 3 (3), 250- 264.

[34] Naccarella, L. , Raggatt, M. , Redley, B. , 2019. The influence of spatial design on team communication in hospital emergency departments. HERD 12 (2), 100- 115.

[35] Pachilova, R. , Sailer, K. , 2020. Providing care quality by design:a new measure to assess hospital ward layouts. J. Architect. 25 (2), 186- 202.

[36] Pati, D. , Harvey, T.E. , Pati, S. , 2014. Physical design correlates of efficiency and safety in emergency departments:a qualitative examination. Crit. Care Nurs. Q. 37 (3), 299- 316.

[37] Pati, D. , Pati, S. , Harvey, T.E. , 2016. Security implications of physical design attributes in the emergency department. HERD 9 (4), 50- 63.

[38] Pouyan, A.E. , Ghanbaran, A. , Shakibamanesh, A. , 2021. Impact of circulation complexity on hospital wayfinding behavior (Case study:milad 1000-bed hospital, Tehran, Iran). J. Build. Eng. 44, 102931.

[39] Sadek, A.H. , Shepley, M.M. , 2016. Space syntax analysis:tools for augmenting the precision of healthcare facility spatial analysis. HERD:Health Environments Research & Design Journal 10 (1), 114- 129.

[40] Schaumann, D. , Breslav, S. , Goldstein, R. , Khan, A. , Kalay, Y.E. , 2017. Simulating use scenarios in hospitals using multi-agent narratives. Journal of Building Performance Simulation 10(5-6), 636- 652.

[41] Tang, K. , Chen, B. , 2023. Resilient hospital design:from crimean war to COVID-19. Herd 16 (4), 36- 55.

[42] Turner, A. , Doxa, M. , O'Sullivan, D. , Penn, A. , 2001. From isovists to visibility graphs:a methodology for the analysis of architectural space. Environ. Plann. Plann. Des. 28 (1), 103- 121.

[43] Valipoor, S. , Hatami, M. , Hakimjavadi, H. , Akçalı E. , Swan, W.A. , De Portu, G. , 2021. Data-driven design strategies to address crowding and boarding in an emergency department:a discreteevent simulation study. HERD 14 (2), 161- 177.

[44] Vearrier, L. , Derse, A.R. , Basford, J.B. , Larkin, G.L. , Moskop, J.C. , 2022. Artificial intelligence in emergency medicine:benefits, risks, and recommendations. J. Emerg. Med. 62 (4), 492- 499.

[45] Wang, Z. , Xiong, X. , Wang, S. , Yan, J. , Springer, M. , Dellinger, R.P. , 2018. Causes of emergency department overcrowding and blockage of access to critical services in Beijing: A 2-year study. J. Emerg. Med. 54 (5), 665- 673.

[46] Weyand, J.S. , Junck, E. , Kang, C.S. , Heiner, J.D. , 2017. Security, violent events, and anticipated surge capabilities of emergency departments in Washington state. West. J. Emerg. Med. 18 (3), 466- 473.

[47] Xuan, X. , Chen, X. , Li, Z. , 2020. Impacts of nursing unit design on visibility and proximity and its influences on communication, privacy, and efficiency. HERD 13 (2), 200- 217.

[48] Yuan, H. , Zhou, Y. , 2024a. An agent-based workflow for evaluating interpersonal visibility in healthcare environment. J. Asian Architect. Build Eng. 1- 20.

[49] Yuan, H. , Zhou, Y. , 2024b. Impact of floor plans on visibility among healthcare members in inpatient care units:employing agentbased simulation and social network analysis. Frontiers of Architectural Research 14 (2), 295- 314.

[50] Zamani, Z. , 2019. Effects of emergency department physical design elements on security, wayfinding, visibility, privacy, and efficiency and its implications on staff satisfaction and performance. HERD 12 (3), 72- 88.

RIGHTS & PERMISSIONS

The Author(s). Publishing services by Elsevier B.V. on behalf of Higher Education Press and KeAi.