It’s not uncommon to walk through the emergency department (ED) of any hospital and find people waiting for treatment. The Centers for Medicare & Medicaid Services attributes the delay in treatment and overcrowding to several issues, including not enough staff to treat patients, lack of space, or inadequate coordination among hospital departments to move patients from the ED to an inpatient bed or other department. Between 2001 and 2008, hospitals closed nearly 198,000 inpatient beds, according to a 2013 research report, “The Evolving Role of Emergency Departments in the United States,” by the Rand Corporation. This happened as use of emergency departments grew at twice the rate of population growth, states the report.

While it’s reasonable to think that the rising number of urgent care centers and retail clinics could alleviate some of this demand by treating patients with minor health concerns, it’s estimated that only 29 percent of the U.S. population lives within 10 minutes of one of these facilities, according to the article, “How Many Emergency Department Visits Could be Managed at Urgent Care Centers and Retail Clinics?” published in Health Affairs in September 2010.

Furthermore, patients in the ED who are admitted to the hospital may find themselves waiting again for an inpatient bed to become available. The American College of Emergency Physicians (ACEP) states that inpatient boarding is a leading cause of overcrowding in the ED. In other words, all the other patients in the hospital don’t leave enough room for patients in the ED to be quickly admitted. This creates a vicious cycle: The longer it takes to transfer patients from the ED to a treatment unit, the longer the delay for a room in the ED to be available to see those still waiting to be treated.

Slow operations in the ED can lead to poorer outcomes like treatment delays, increased stress, decreased satisfaction, and overwhelmed staff. This situation can impact patient satisfaction scores, which, in turn, impact reimbursement levels for facilities.

To help address the issue, healthcare designers are implementing creative strategies within the built environment to improve throughput in the ED and ensure patients are treated in a timely fashion. The Center for Health Design’s Emergency Department Throughput Toolbox offers several ideas, including:

• Reducing the traditional triage process by providing universal rooms and beds with telemetry capabilities, so that patients can be registered and evaluated in any room, and providing a self-service registration kiosk where patients can enter their demographics and health issues.

• Designating a specific area, such as admissions holding area or an express admission unit, to board patients who’ve already been seen and are waiting to be admitted to free up ED beds.

• Offering a separate fast-track lane to treat patients with minor injuries and illnesses more efficiently, leaving the ED rooms to those with more serious injuries. Equipment and storage that’s required for these minor injuries could be stored in this fast-track area.

• Locating laboratories where the patient is being treated (point-of-care testing) to increase the pace of discharge, expedite triage, and decrease delays.

• Using technology, such as computerized whiteboard that sync with electronic patient records, to provide real-time tracking to ensure that test results and diagnostic procedures are conveyed to all team members quickly. This enhanced level of communication allows for quicker decisions, potentially moving patients through the ED faster.

• Developing flexible treatment rooms that can accommodate diverse patient needs and situations, improving access to care and reducing the need for patients to wait for a room specific to their needs.

Investing in some new design strategies can help improve throughput so that patients can quickly and easily receive the care they need and the staff can feel more productive. However, these strategies will only be effective if other elements, like operations and culture are also modified to reflect the intention of these design strategies.

For more best practices in emergency department design, check out The Center for Health Design’s Emergency Department Throughput Toolbox. For more information, visit

Lisa Ellis is a Boston-based freelance writer for The Center for Health Design. She can be reached at