Design Efficiency in Emergency Departments

Overcrowding is a common occurrence in emergency departments worldwide. It causes poor patient satisfaction and inadequate care leading to even poorer patient outcomes and increased healthcare costs.

Emergency Department (ED) efficiency, therefore, is one of our hospitals’ biggest and most consistent challenges.

While shorter patient journey times are associated with improved patient satisfaction and reductions in mortality and morbidity, crowding tens to be associated with a reduction in the quality of care delivered, whether real or perceived.

Crowding of the ED can often adversely affect health outcomes for patients and even contribute to patient readmissions, creating a vicious cycle for an already troubling crowding problem.

Hence, optimizing patient flow is a critical part of improving healthcare systems.

While you might think that the problem is people-based – whether that be doctor-to-patient ratios, administration organization, or community demographics – the role of design and space management can actually have a significant impact on ED wait times. In addition, most of these changes come with lower long-term costs than a lot of other solutions.

In fact, survey results have found that the number one improvement healthcare providers would like to see in their clinical environment was a more comfortable and efficient workspace.

Take Bon Secours Community Hospital in New York, for example: After redesigning its ED, the hospital was able to reduce wait times by 10%, clocking in at a 12 minute per patient average.

These developments are even more significant considering that the ED is fast becoming the hospital’s new front door. It is thus imperative for leadership to rethink the ED within the context of its relationship to the rest of the hospital.

While many EDs today are undersized, simply adding more rooms overlooks many other important considerations about the role of the ED as well as how care is delivered.

This article will explore the key considerations to effective space management in ED departments that can not only improve the individual patient experience but can better serve the health needs of the community.

Bettering Patient Flow

Intervention at the initial assessment stages is the first and most important point of improvement, as this stage will determine the rest of the patient’s flow throughout the hospital.

Properly assessing patient needs before being transferred to treatment beds is critical for maintaining flow and reducing overcrowding because once non-acute patients are put into beds and deemed “horizontal,” they are treated the same as those with more acute ailments.

By designing initial areas to allow patients to remain “vertical” or in a seated position, fewer specialty-focused staff members are required to assess them properly. Implementing comfortable seating will not only keep patients “vertical” but will also increase comfort and reduce the anxiety a long wait can spur.

A hospital in Nevada took this approach and prioritized improved seating areas to efficiently move lower acuity patients through the system, which resulted in a 70% decrease in care time. Not only does this intervention benefit these patients’ experience, but higher acuity patients receive the urgent and very specific care they need as specially trained ED staff are freed up.

Optimizing Fast-Track Units

Space is at a premium in hospitals, especially in the ED. By optimizing the space available, the designated area for treatment of low-acuity patients can help to significantly reduce overcrowding.

For example, by putting multiple beds in fast-track rooms and efficiently using partitions, patient privacy can still be maintained while allowing staff to care for multiple low-acuity patients in the same space. A designated holding area for fast-track patients can also be used to pull these patients out of the general waiting room to make more space for new patients.

Adding Concierge Services

Doctors and nurses lose time performing clinical functions because they are easy targets for patient and visitor questions when they are en route.

Adding strategically placed concierge services to help patients and visitors get their questions answered can bring big benefits such as increased comfort and feelings of care and improve the emergency department experience for all as work is done more efficiently.

Improving Proximity to Support Services

Improvements in the proximity of support services, such as the laboratory and imaging services, can also help facilitate patient throughput.

In fact, integration is the overriding theme influencing medical technologies and design. Traditional boundaries between imaging, surgical, and related patient care technologies are breaking down, making care centred around the patient and effectively reducing information flow times.


Studies have shown that patients and physicians benefit from specialists collaborating with their colleagues. While this may work well naturally in a low-volume ED, collaboration and communication are much harder in EDs with higher volumes of patients.

Larger EDs can be zoned so that each zone contains space for a care team and that the zone is equipped with appropriate supplies, equipment and support spaces.  Segmenting care by patient type also allows better resource and staff allocation.

Integrating Flexible Design

The needs of the ED ebb and flow very dynamically. By incorporating design elements that maximize space useability and flexibility, hospitals can make full use of the ED space regardless of current demand and smoothly adapt in real-time to changes in need.

Adding Wayfinding Elements

Clear paths of movement in an ED are essential to both staff efficiency and patient and visitor safety and flow. Wayfinding is particularly important for creating good flow through emergency departments, saving both time and energy.

By providing clear signage, colour-coding areas, providing visual landmarks, and assuring good lines of sight, wayfinding can be improved and increase patient satisfaction and care.

Implementing Wait-Time Monitoring Systems

To meet waiting time goals, hospitals can use an electronic system to monitor wait times.

The clock begins ticking when the patient registers and continues as they are seen by a triage nurse and medical provider. If the patient’s wait time exceeds the set goal, then the system can alert staff of the delay, and appropriate action can be taken.

Upgrading Physician Workstations

Workstations for physicians and advanced practice providers (APPs), to date, have not been tailored to the increasingly digitized workspace, nor to the providers’ needs. The physician and APP workspace should consider comfort and efficiency, with a primary design objective to improve quality and patient safety.

A critical first step to improve the provider environment is ergonomic and functional workstation design. Ideally, a provider workstation would be located near the nurses’ station but not at a location that results in frequent interruptions.

Does Your ED Need Optimizing?

Knowing whether your ED space is in need of a makeover can be determined by tracking key data points, including patient volume, percent of patients admitted, LWBS rate, door to provider, door to bed, bed to provider, LOS for both admitted and discharged patients, and the longest wait time in the waiting room.  These indicators can not only indicate whether your ED is performing at average levels, but they can also help identify where the issues are taking place and thus how you should go about solving these issues.

Integrated data management software can make tracking and analyzing this data easy so that your decisions can be made fully informed. Horizant specializes in customizing data management solutions that suit your needs and goals. Contact our team today to learn how we can help you improve your patient experience and optimize your healthcare system.