Health by Design: “I demand the cone of silence!”

You’re playing a Saturday sporting match. Feeling great like you were 16 again, go in for a tackle and ‘snap’ excruciating pain, is it a break? a sprain? a tear? So instead of propping up the bar later that day having a cold one, you end up in the Emergency Department lying on a trolley chewing on pain medication. Not what you expected and now your waiting… for an x-ray…. a review… a specialist… a splint… a bed on the ward…and after you have Facebooked, Twittered, Snapchatted and Instagrammed you lie there, not much to do but watch and listen. After waiting a while you know all the intimate details of the people around you, the physio is going out for dinner with a new date, the doctors are handing over their patients for the day, the guy to the left of you might be having a stroke, the woman to the right drank way too much, has a foul mouth and is now vomiting. Across the aisle a DIY accident, and next to him, well some things should remain private. How do you know this? Because there is a screen of blue cotton 180 thread count between you and everyone else in this area of the ED.

1. Interior Emergency Department, Perth.

Your health information is sensitive, and confidentiality between a health practitioner and patient is taken for granted. The nurse’s National Code of Conduct even specifies that nurses must, ‘provide surroundings to enable private and confidential consultations and discussions, particularly when working with multiple people at the same time, or in a shared space.’¹ The definition of privacy is, ‘a state in which one is not observed or disturbed by other people.’ However, if you have had the unfortunate experience of ending up in an Emergency Department you will understand the architecture is not always accommodating to ones ‘privacy’. However it isn’t as easy as ‘whacking up a few walls’ around each cubicle to make the environment more private. Responses to individual concerns of the present does not make for good design and in doing so may cause problems with the other systems and workflows.

In the past the ED layout provided a function, predominately for medical intentions, treatment and infection control. The open plan layout with curtains dividing trolleys served the purpose. From anecdotal conversations society wasn’t ‘patient centred,’ and a patients privacy wasn’t high on the priority list. However architecture is changing and the design development ‘is now a shared responsibility of all involved from conception to realisation, it is a team approach.² A strong design process includes all stakeholders, collaboration of experts, and a concentrated effort to understand the end user and the environment wihin which the architecture is to serve. In the design of health facilities the interaction of form and function is now understood to be very complex.

There is a plethora of information for those involved in the design of Emergency Departments. Guidelines and standards outlined by government bodies and industry organisations, evidence based research, and collaboration with user groups is helping to understand this multifaceted beast. Now the psychology of the ‘end user’, patient flow, acuities, systematic operations, work flows, technologies, communications, and their often complex interactions need to be understood. To add yet another dimension future trends, flexibility and futureproofing of spaces need also be a focus.

2. CAVE2, allowing 3D virtual reality walk through building models. Another source of information allowing the team to understand how the built form will influence the end user.
3. Is this the future of low acuity ED areas? Designing spaces responding to the acuity of patients. Flexible seating, digital booths, separating consultation and waiting areas.
4. ED Epworth Hospital, Melbourne, Critical care area. HIgh acuity patients. Larger private spaces, Use of switchable glass, translucent to opaque, for privacy.
5.Research & Development of different ED models. Circular pods for low acuity or sitting patients.
5. Small adaptable staff work space. Understanding communication patterns. Different multiple work station spaces in the ED, design dependent on who is communicating to whom and the subject.

With all this information the design of the future Emergency Departments is rapidly changing and through good design outcomes you may no longer have to share your most intimate stories and the sounds of your bodily functions with those around you. However for now you may have to quote Maxwell Smart,


7.                                         ”Nurse”…..”I demand the cone of silence!” ‘





1.Nursing and Midwifery Board of Australia, Code of Conduct for Nurses, (March 2018, p10), accessed 22 March, 2018.

2. Office of the Victorian Government Architect, Government as Smart Client, Melbourne, Office of the Victorian Government Architect, Edition 01,August 2013, p9.

1. Emergency Department Perth Metropolitan Hospital, Source Anonymous.

2. Meet the 21st century Microscope. A peak into the Monash CAVE2 Immersive visualisation facility powered by NVIDIA. Singapore Hardware Accessed 22 March 2018. A Lidar (light detection and ranging) mapping demo walkthrough of a floor within a building.

3. Dan Howarth, “Dezeen Book of Ideas: Recovery Lounge by Priestmangoode.” Dezeen, 29 November, 2012.

4. Liz McLachlan, “Epworth Richmond offers the future of emergency medicine” The Weekly Review, February 17, 2016.

5. “Emergency Department Care Initiation.’ PDS Pomarico Design Studio. Accsessed 22 March, 2018.

6. “Children’s Hospital of Philadelphia, Medical Behavioural Unit,” ZGF. Accessed 22 Mar, 2018.

7. “Cone of Silence Device,” Wikipedia, accessed 22 March 2018, Cone of Silence from Episode 1 (“Mr. Big”, 1965) of Get Smart

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