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Modular construction can help relieve crowded emergency departments (EDs) only when it is paired with a staffed crisis service and a referral network. The proposal described by Stantec combines rapidly deployed prefabricated units—where medically stable people can receive assessment and short-term care—with regional hospital hubs that accept referrals from several EDs. The building supplies capacity; the network supplies clinical access, transport, records and follow-up.
This is a design and care-delivery proposal, not proof that modular construction alone fixes the mental-healthcare crisis. Stantec’s examples show a rapid-build overflow facility in Calgary and a distributed psychiatric emergency service in Alameda County. They demonstrate separate parts of the model, and Stantec does not present either as an evaluation of a combined modular crisis system.
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Why combine modular units with a regional hub?
People in psychiatric crisis often remain in a medical ED while they wait for assessment, an inpatient bed or a referral destination. Stantec’s 2023 article reports an average referral wait of 7–10 hours, attributing the figure to its own article rather than providing a study method or underlying dataset. A dedicated ambulatory crisis setting could separate that work from general emergency traffic while preserving medical escalation when a patient’s condition requires it.
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1Clear out junk files and repair common Windows errors2Fix the driver behind crashes, sound loss and screen glitches3Repair Windows errors before they cause bigger problemsThe proposed arrangement has two linked layers:
- Local crisis units: small, quickly deployable facilities located beside a hospital or connected directly to it. They would accept medically stable patients for assessment and care for stays of up to 23 hours.
- Regional hubs: hospitals or specialist centers that receive referrals from multiple EDs, coordinate psychiatric expertise and connect patients with community and rural services.
Neither layer is sufficient by itself. A unit without 24-hour clinicians, transport and referral agreements becomes an empty shell; a hub without nearby capacity leaves patients boarding in EDs.
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What the available figures do—and do not—establish
The following numbers are claims reported by Stantec in 2023. The article does not name the underlying studies, describe methods or provide independently verified benchmarks, so they should be used as planning prompts rather than guaranteed outcomes.
| Claim in Stantec’s article | How to interpret it |
|---|---|
| Roughly one quarter of the U.S. population faces a mental-health challenge each year, and half will go undiagnosed and untreated. | A broad estimate attributed to Stantec; the article supplies no study citation or definition of “challenge.” |
| Average ED referral wait: 7–10 hours. | A reported average, with no stated geography, sample or measurement period. |
| Up to three other patients might be seen in an ED for each patient transferred to a dedicated modular crisis unit. | A potential throughput effect, not a measured result from a modular crisis-unit evaluation. |
| Average U.S. ED cost to board a psychiatric patient: $2,264. | A reported average with no cost year, payer mix or methodology in the article. |
| Calgary’s pandemic response unit added more than 60 examination spaces in 22 days. | A project delivery claim for one facility, not a universal construction schedule. |
For the source’s full proposal and qualifications, see Stantec’s May 18, 2023 article. A later Building Design + Construction republication is available at BDC Network; it carries substantially the same content and is not independent corroboration.
Two precedents, two different functions
Calgary and Alameda County should not be treated as competing products. One illustrates rapid physical expansion; the other illustrates care routing across a network.
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| Precedent | What it demonstrates | Reach and reported figures | What it does not demonstrate |
|---|---|---|---|
| Peter Lougheed Hospital Pandemic Response Unit, Calgary, Alberta | A separate prefabricated structure used for emergency-department overflow during COVID-19. | Stantec says it was built in 22 days and added more than 60 examination spaces beside the ED. | It is not an evaluation of a psychiatric modular crisis program or of a regional referral network. |
| John George Psychiatric Hospital Emergency Services, Alameda County, California | A psychiatric emergency service that accepts medically stable patients for assessment and referral outside ordinary medical EDs. | Stantec says the service works with 11 EDs and reportedly bypasses medical emergency rooms in two-thirds of cases. | The article does not identify a modular building or provide outcome, cost or wait-time comparisons. |
Calgary: a construction and overflow precedent
Stantec says its healthcare team designed the Pandemic Response Unit at Peter Lougheed Hospital. The separate prefabricated structure was supplied by Sprung Structures and used modular Falkbuilt headwalls. According to Stantec, the unit was built in 22 days, added more than 60 examination spaces adjacent to the ED and was intended to remain available for ED overflow. Clinicians described the facility as “a godsend,” but no individual clinician is named.
Alameda County: a routing and referral precedent
Stantec describes John George Psychiatric Hospital Emergency Services as a service connected to 11 regional EDs. It accepts medically stable patients for psychiatric assessment and referral, and Stantec reports that two-thirds of cases bypass medical emergency rooms. The operational lesson is the referral agreement and clinical pathway—not a particular construction system.
What a modular crisis unit would need to provide
A site that is close, calm and medically connected
Stantec says a unit could fit within the width of a standard parking aisle. That makes hospital campuses, constrained urban sites and temporary expansions possible options, but a footprint is not a site plan. Leaders still need ambulance access, fire and life-safety clearances, utilities, infection-control provisions, secure staff circulation and a clear route to higher-acuity medical care.
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Direct access to a hospital, or a physically connected link, lets staff escalate patients whose medical condition changes. A freestanding location needs an explicit transfer agreement, transport time standard and receiving team; otherwise “off-site capacity” can simply move the delay to another handoff.
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The proposed setting is ambulatory rather than an inpatient psychiatric ward. A 23-hour maximum can support observation, assessment, medication initiation, safety planning and referral while preserving inpatient beds for people who need them. The operating policy must define who is medically stable, how suicide and violence risk are assessed, when involuntary-treatment laws apply, and what happens when no suitable destination is available before the time limit.
A therapeutic environment with choice and dignity
Stantec proposes gardens or patios, daylight, fresh air and layouts that let patients choose different levels of stimulation and engagement. Those features should be translated into observable design requirements: quiet and active zones, visual supervision without constant exposure, durable and ligature-aware details, accessible toilets and showers, family or peer meeting space, and safe outdoor circulation. “Therapeutic” should be tested with patients and staff, not assumed from a rendering.
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Multidisciplinary coverage around the clock
Stantec calls for 24-hour teams that may include psychiatrists or psychiatric nurse practitioners, nurses, licensed or credentialed clinicians able to complete assessments, and peers with lived experience. The staffing plan must specify minimum coverage by shift, medical backup, security, social-work and substance-use expertise, supervision, handover routines and surge staffing. A modular shell cannot deliver assessment, de-escalation or discharge planning without these roles.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Designing the hub-and-spoke network
Define the hub’s authority
A regional hub should own the clinical protocol, consultation line, bed and appointment visibility, data exchange and escalation rules. It can support several community “spokes,” including rural services that cannot maintain specialist coverage at all times. Governance agreements should identify who accepts a referral, who pays for transport, who obtains consent, and who remains responsible after discharge.
Make the referral pathway explicit
- Screen at the originating ED or crisis contact. Confirm medical stability, immediate safety needs, identity, language and accessibility requirements.
- Contact the hub or crisis-unit intake team. Send the minimum clinical information needed for a decision and obtain an acceptance time.
- Move the patient safely. Use an agreed transport level, with clinical escort when risk requires it, and document custody of medications and belongings.
- Assess and stabilize in the unit. Provide psychiatric evaluation, nursing observation, peer support and medical escalation under the 23-hour operating rule.
- Close the loop. Arrange inpatient admission, community treatment, primary-care follow-up, housing or substance-use services, and communicate the plan to the referring team.
Include rural and underserved communities from the start
A hub model can extend specialist access through telepsychiatry, scheduled outreach and shared protocols, but geography still affects transport time and continuity. Map catchment areas, weather and road constraints, language needs, broadband reliability and local crisis resources before selecting a hub location. A network that counts referrals but cannot return patients to a safe community setting will create a different bottleneck.
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What prefabrication can change in delivery
Stantec identifies several potential advantages: more work completed in a factory, shorter on-site construction, repeatable quality checks, adaptable or reusable modules, less disruption to an operating hospital and possible indoor-air benefits. These are design and vendor claims, not quantified comparisons with conventional construction. Each project should verify them through its own schedule, commissioning records, infection-control plan and post-occupancy review.
Factory work does not remove site work
Foundations, utility connections, grading, fire access, permits, inspections, commissioning and clinical equipment installation still occur at the site. Hospital projects also require infection-prevention barriers, noise and vibration controls, temporary wayfinding and coordination with oxygen, power and information-technology systems. A short module-fabrication period can be offset by late approvals or an unprepared site.
Plan for adaptation and reuse
Standardized room dimensions and demountable services can make future conversion easier, but reuse depends on structural condition, decontamination, code compliance, transport and a new site’s utilities. Write those requirements into the employer’s brief instead of treating “reusable” as an automatic residual value.
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- Quantify the bottleneck. Measure psychiatric ED arrivals, referral waits, boarding hours, transfers, failed discharges, peak demand and rural travel times by hour and day.
- Set the clinical scope. Decide which patients the unit can accept, the 23-hour observation policy, medical exclusion criteria, emergency response and legal responsibilities.
- Model the network. Identify the hub, participating EDs, community providers, inpatient beds, transport partners and information exchanges. Test demand surges and simultaneous transfers.
- Choose the site and module brief. Confirm access, utilities, security, outdoor space, accessibility, infection control, staff support areas and future expansion zones.
- Procure design and construction together. Require a single coordinated schedule for permits, foundations, factory production, delivery, installation, commissioning and clinical readiness.
- Recruit and train before opening. Staff the full operating model, rehearse handoffs and escalation, and include peers in service design and orientation.
- Launch with measurement. Track wait to assessment, time from acceptance to arrival, completed referrals, transfers to inpatient care, restraint and seclusion, patient experience, staff safety, readmissions and equity by geography and demographic group.
Common failure modes and safeguards
- Building before staffing: fund recurring clinical posts and backup coverage before ordering modules.
- Calling an ED overflow space a crisis service: publish clinical eligibility, observation, treatment and discharge standards.
- Ignoring the last mile: contract transport and receiving services for evenings, weekends and weather disruptions.
- Optimizing speed over safety: complete ligature, fire, accessibility, infection-control and behavioral-health risk reviews during design, not after installation.
- Counting rooms instead of outcomes: evaluate reduced boarding and safe transitions, not only examination-space capacity.
- Assuming one precedent proves the whole model: treat Calgary as evidence about rapid construction and Alameda as evidence about network routing; validate the combined design locally.
How leaders should evaluate the proposal
Use a business case that separates capital, site preparation, equipment, transport, staffing, training, maintenance and recurrent clinical costs. Compare the modular option with renovation, permanent construction and service redesign on the same demand assumptions. Require sensitivity tests for lower referral acceptance, higher acuity, delayed inpatient placement and staffing vacancies.
Commission an independent evaluation with a baseline period and a defined comparison. Useful measures include ED psychiatric boarding hours, time to specialist assessment, proportion of referrals completed within 23 hours, transfers requiring medical escalation, patient-reported experience, staff injury and turnover, and access for rural or marginalized populations. Stantec’s reported figures can motivate these measures, but they should not be substituted for them.
The strongest case for modular crisis units is therefore conditional: a rapidly delivered, hospital-connected environment can add capacity while a hub-and-spoke service makes that capacity clinically usable. Success depends on staffing, referral governance, transport, community destinations and transparent measurement as much as on the prefabricated structure.
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