Many factors are at play today in shaping the future of the emergency department (ED), a space that’s likely to face rising demand.

“From my experience, most of the emergency departments are picking up patient volume,” says Craig Pickerel, project manager and architect at SSOE Group (Toledo, Ohio). “Some of it has to do with some people now getting care who weren’t before. Also, with the aging population, older people are more likely to have chronic medical conditions.”

As healthcare systems continue to consolidate and close hospitals, the EDs that remain open are starting to experience higher patient volumes. Meanwhile, providers are also exploring the construction of freestanding EDs, which are popping up in communities to deliver care closer to where patients live and adding competition to the emergency care market. The introduction of specialty ED units also continues, although not as rapidly as some had predicted, targeting specific patient populations, such as pediatric, geriatric, or behavioral health.

Many organizations are responding to the evolving marketplace by making operational changes to treat existing patients in a more effective manner, rethinking layouts that speed up throughput, and improving aesthetics to make the front door to their hospital as pleasing an experience as possible.

Keep Care Moving

Registration and triage have always been the first stops for patients in the ED, but many facilities today are beginning to staff these frontline areas with physicians who can diagnose patients as quickly as possible and determine if they should move through the traditional ED process or to a more clinical setting for nonemergency care.

“By putting a physician there, you get a higher level of evaluation,” says Jeff Brand, design principal and national practice area leader for healthcare at Perkins Eastman (New York). “Another advantage is that in the old EDs, you’d have to repeat your stories many different times. Now, you have a doctor and nurse right at the front door, they evaluate you, interview you once, and that story is the story. There’s no room for further error.”

Another change is the expansion of fast-track care, an approach that’s been growing in usage in the emergency department for some time. Designed to treat patients with less serious injuries, facilities are giving fast track more space as a means to improve service, reduce door-to-provider time, control treatment costs, and reserve exam room beds for those truly in need.

Smaller exam rooms can be used here and require fewer pieces of equipment and furnishings, with many rooms using a recliner or stretcher instead of a full-size patient bed. As the concept takes off, facilities are also increasing the number of fast-track rooms and incorporating separate lab and staff areas, as well as waiting rooms.

Out of Room

Alternative waiting spaces are also growing in adoption as another effort to improve throughput within the ED. These areas are separate from the main waiting room and can feature open or semiprivate designs. “If I’m waiting for an X-ray or a blood test and I’m feeling OK, then give the exam room to someone who really needs it and put me in a different type of setting,” Brand says. “You have to route people to where they need to be.”

For example, the Lenox Hill HealthPlex freestanding ED in New York uses a separate area for patients who are waiting for test results or discharge instructions. The semiprivate cubicles are located in the core of the main ED and are equipped with iPads.

Designers and architects say that when space is available, it’s important to include a separate waiting space for fast-track patients, in particular, to streamline flow and reduce irritability and confusion among patients and family members in regular ED care who might question why someone is being treated faster than them. During the renovation of the Methodist University Hospital in Memphis, Tenn., a rapid assessment and results waiting room were combined into one space. “[Patients] can still be in a controlled environment, but they’re not taking up an exam room,” says Jon R. Summers, principal, BRG3S Architects (Memphis).

Warmer Welcome

Many of the design elements and aesthetics that have become must-haves in inpatient areas are also finding a home in the ED. Traditional curtained exam areas are being replaced with private rooms, helping to improve patient satisfaction, privacy, and infection control.

Facilities are also moving away from sterile or institutional-like settings and adding warm materials and color palettes, residential-style furnishings, decorative lighting, and artwork.

A renovated ED at ProMedica St. Luke’s (Maumee, Ohio) features a fireplace in the waiting room, wood-like materials on the floors and headwalls of the private exam rooms, and artwork throughout the department.

These efforts go a long way toward making a facility a welcoming and inviting place, Pickerel says. “A lot of times the emergency department is the introduction to the hospital for patients,” he says. “A well-maintained space can transform the perception of care.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at

For a look at some recent emergency department projects and design trends, read “Healthcare Design Pulse: Cutting-Edge Emergency Departments,” or check out Healthcare Design’s December issue.