Facility Implications of COVID-19 Report

February 2021
The Agnew Peckham team has developed a report outlining recommendations for facility planning based on...

Emergency Department Space Research Study

September 2015
To update/validate the current Ontario standard, Agnew Peckham engaged twenty-seven Ontario hospitals in a modified...

Emergency Department Space Research Study

A considerable number of emergency departments were built or significantly renovated as an outcome of Ontario’s Health Services Restructuring Commission (HSRC) directions.  Departments redeveloped at HSRC direction were sized (and costed) based on a “visits per square foot” standard which has been applied in Ontario, with minor adjustment, since the late 1990’s.  Many have expressed concerns about the validity of this standard and the deficiencies that have resulted from its application, citing undersized rooms, missing rooms and insufficient number of rooms as well as poor configurations as examples of the problem.   In general, the deficiencies compromise the Ministry of Health and Long-Term Care (MOHLTC) Health Capital Investment Branch’s (HCIB’s) OASIS planning principles of operational efficiency, accessibility, safety and security, infection prevention and control and sustainability. 

To update/validate the current Ontario standard, Agnew Peckham engaged twenty-seven Ontario hospitals in a modified post-occupancy evaluation (POE) process which linked facility size with user feedback and performance data.  The initiative was performed pro bono as part of Agnew Peckham’s Centre for Innovation in Health Facility Planning Inc.  Hospitals were invited to participate based on Agnew Peckham’s knowledge of the emergency department and when it was built or renovated.  Only emergency departments built or significantly renovated over the past 15 years were included.

The study methodology comprised completion of an online questionnaire, a follow-up interview and subsequent data and space analysis.  HCM Group Inc., our data partner, provided 2013/14 ED visit data by triage category and ED patient days, the latter being an important indicator of treatment area use.

Hospitals were grouped for analysis, based on total number of visits:

  • Group I:                  under 30,000 visits
  • Group II:                 30,000-56,000 visits
  • Group III:                 56,000-80,000 visits
  • Group IV:                 greater than 80,000 visits


This study found that the current MOHLTC guideline for visits/Component Gross Square Feet (CGSF) (3.15-3.64 visits per square foot) does not accommodate needed emergency capacity and space.

All participating hospitals identified ED space deficiencies, with general patterns being:

  • Treatment spaces:  over 80 per cent reported an insufficient number
  • Procedure room size:  more than 55 per cent reported that procedure rooms were undersized for needs
  • Mental health rooms:  over 35 per cent reported undersized space

Space requirements will continue to evolve with changes in clinical practice, equipment needs, technological advances, patient safety, patient confidentiality etc. Ultimately, the space requirements for any emergency department can only be fully determined through a functional program process. 

For more information, please contact Lucy Brun, Partner, at