Toward Building Surge Capacity: Potentially Effective Spatial Configurations in Emergency Departments

HERD. 2022 Jul;15(3):42-55. doi: 10.1177/19375867221096639. Epub 2022 May 2.


Background: Emergency departments (EDs) have been struggling with overcrowding issues for years. Some spatial configurations have been proposed to improve ED performance in facing overcrowding. Despite similarities with mass casualty incidents (MCIs), when demand for care exceeds the capacity, little is documented about the application of the proposed configurations during MCIs to improve surge capacity.

Objectives: We aimed to explore the potential of spatial configurations that have been proposed to handle ED overcrowding in daily operations so as to improve surge capacity during MCIs.

Methods: Using an online Likert-scale survey, 11 spatial design strategies were rated by ED care teams in terms of their potential to improve surge capacity during MCIs.

Results: Responses from 72 participants revealed that establishing an in-house lab was perceived as the most potential strategy, followed by rapid care area, internal waiting rooms, and in-house imaging. In contrast, separate entrance and exit doors, as well as decentralized nurse stations, were perceived as the least potential strategies but also exhibited the most variance in response. Respondents' comments implied that their choice of in-house ancillary services was primarily to improve communication and to reduce turnaround time and risk of errors. Their choice of rapid care and internal waiting areas related to improved flexibility.

Conclusions: Understanding clinicians' perspectives on potentially effective spatial configurations aids in implementing balanced strategies to better equip EDs to handle overcrowding in daily operations and manage surges during MCIs.

Keywords: dedicated imaging; dedicated lab; emergency department design; internal waiting; mass casualty incident; overcrowding; rapid care; spatial configuration.

MeSH terms

  • Emergency Service, Hospital
  • Humans
  • Mass Casualty Incidents*
  • Surge Capacity*