Adapting to Change: A Systematic Literature Review of Environmental Flexibility in Emergency Departments

PURPOSE

This study aimed to offer a comprehensive analysis of distinct design strategies identified, evaluated, or discussed in the existing literature that promote environmental flexibility in the context of emergency departments (EDs).

BACKGROUND

EDs are subject to constant changes caused by several factors, including seasonal disease trends, the emergence of new technologies, and surges resulting from local or global disasters, such as mass casualty incidents or pandemics. Thus, integrating flexibility into ED design becomes crucial to effectively addressing these evolving needs.

METHODS

A systematic search was conducted in four databases: CINAHL, MEDLINE, PubMed, and ScienceDirect, in addition to a hand search. A two-stage review process was employed to determine the final list of included articles based on the inclusion criteria. Included studies were evaluated for quality, and findings were categorized using a hybrid deductive and inductive coding approach.

RESULTS

From the initial yield of 900 records, 22 studies met the inclusion criteria and were included in the final full-text review. The identified design strategies were organized into five categories: modifiability (n = 13 articles), versatility (n = 8 articles), tolerance (n = 6 articles), convertibility (n = 4 articles), and scalability (n = 7 articles). Specific design strategies under each category are reported in detail.

CONCLUSIONS

Our findings suggest that most flexibility design solutions are based on anecdotal evidence or descriptive studies, which carry less weight in terms of reliable support for conclusions. Therefore, more studies employing quantitative, relational, or causal designs are recommended.

Does Blindness Boost Working Memory? A Natural Experiment and Cross-Cultural Study

Intelligence requires sufficient working-memory capacity. Traditionally, working memory was seen as a process and as a prerequisite for fluid intelligence. Working memory was assumed to be determined by maturation and health. There is a gap in the literature: It is still not fully understood to which extent and how working memory can be influenced. So this study tested how visual impairment and the extent of visual impairment are related to working memory capacity. In our study we compared N = 249 children (6–16 years) with and without visual impairment (blind, visually impaired, and sighted) in two countries (South Africa and Austria) at different development levels on their working-memory capacity and verbal comprehension. Using the WISC-IV, blind and visually impaired children showed higher working-memory capacity than sighted children (r = + 0.35, 14, and 3 IQ points, respectively). On the other hand, visually impaired children showed a weakness in verbal comprehension (r = −0.39, on average 13 IQ points lower). The pattern remained robust when SES and race-ethnicity were controlled. Our natural (quasi-)experiment shows a pattern, which is unlikely to be genetic, and so supports the view that working memory and intelligence scores can be modified.