Patient-Focused Design for a Busy Emergency Department


By Hannah Brewster

This year ADP completed a major remodelling of one of London’s busiest hospitals to create a new emergency care pathway in a dedicated emergency floor. We created a bright yet calming environment where patients are cared for safely and efficiently.

The graphic below tells the story of the five-year project we have lived and breathed; including initial design concepts, a charity abseil with Logan Construction and jelly baby ‘patients’ laid out on drawings for user workshops.    


St Thomas’ Hospital Emergency Department (ED) was originally designed for a capacity of 50,000 visitors per annum. In 2012, when the project commenced, the department was dealing with in excess of 100,000 visitors, increasing to 150,000 in 2018, making it one of the NHS’s busiest EDs.

As part of an overall strategy to improve Emergency Services on the site, a project titled ‘Emergency Care Pathway’ (ECP), was undertaken to more than double the capacity of the ED, to ensure that patients are cared for safely and efficiently in a better environment and to improve the patient journey for the sickest patients.

The brief identified ten sub-uses within the ED and a total of 7500m2 of accommodation, albeit 5500m2 was the maximum footprint achievable. Key drivers were the co-location of 70 acute assessment beds and streamlining the patient pathway from the front door to the most appropriate care.

Completed in six main phases, the works commenced on site in 2014 and completed in Spring 2018. The project involved the remodelling of the whole ED with additional space freed up by the reorganisation of services elsewhere.


With such an extensive remodelling project, the design approach had to allow for the works to be carried out in a 24/7 acute live environment. There was limited space to provide temporary facilities, so a careful and complex sequence of phasing was balanced with providing a full clinical service, maintaining mechanical and electrical services to live areas, affordability, programme and logistics of construction, whilst ensuring a safe environment for all during the works.

This project illustrates how the intelligent remodelling of challenged, live, frontline NHS facilities can support and deliver a new clinical model. The ‘people inspired’ design focuses on the environment through the integration of art, graphics and wayfinding to support the vision. Collaborative working in the briefing, design and construction stages, enabled full integration of the Emergency Care Pathway by optimising space and operational efficiency, whilst protecting the safety, privacy and dignity of patients.




Hannah Brewster

Hannah Brewster

Hannah first joined ADP as a
student and has since worked on
numerous complex healthcare
schemes and rapidly progressed
to become associate director.