The ED of the Future

Let’s say, hypothetically, you could design the ED of the Future. I say hypothetically as there may be a new (like New) ED in my future. Maybe; it sounds like a heck of a challenge. Considering we’re a Trauma Center and currently see nearly 100K/year in volume, and have an admission rate that’s between 18-35%,

What would that new ED look like, from the following viewpoints :

  • the patient
  • the triage nurse (is there one?)
  • the treating nurse
  • the ED doc
  • the consultant
  • the hospital admissions team (billing)
  • the OR
  • the Tele units
  • the Floor units
  • ED discharge areas
  • physical plant

I have a few ideas, but am frankly hamstrung by a lack of ‘out there’ imagination. Let’s hope you’re not similarly limited. Don’t feel like you need to answer all of these, but I’m interested in your ‘out of the box’ ideas…which you’ll get full (if ephemeral) credit for.


  1. The pholks (your parents) have just increased our vocabularies by one more word. Keep challenging us!

  2. No general waiting room.

    I don’t know how to implement that, but that’s always the worst part of the presentation.

    I’m a retired RN. I’ve been to ED most recently because my mom was taken there (several times); I’ve been there with my children; I’ve been there for myself.

    Even without misbehaving individuals, people in pain waiting to be seen, people coughing and throwing up, whatever other overt symptoms are just plain unpleasant. I didn’t want to share my daughter’s fevered wailing with others, but she was sick and couldn’t stop. (Earache, fairly easily treated but as a new parent, what did I know?)

    Maybe assorted sizes of office cubes? Some kind of privacy, ‘please sit here and we promise not to forget you’.

  3. I’m a retired ER doc, and my mom an ER RN (our Thanksgivings were real stomach churners for guests). However, that means I heard about the issues you raised from both sides. So, I’ll focus on this from the viewpoint of the triage nurse, He/She has a system that:
    1) Screens for fraud (fake ID/Address, no Rx for controlled substance)
    2) Identifies which patient is likely to pull a gun in the waiting room
    3) Figures out which patient has hit every ER and urgent care up and down the interstate prior to their arrival (again…you travel like that, you won’t get drugs on the visit)
    4) Knows who is colonized with drug resistant bacteria (so they aren’t playing with the toys in the children’s waiting room)
    5) Figures out who is in need of outpatient drug treatment services before the prolonged Q&A with the doc (that comes, invariably, to the same conclusion)
    6) Saves the doctors and hospital $ to make everyone happier (and make it so there is money for the RNs to get raises!)

    Aww heck, you can probably tell this is in my wheelhouse and I think I have it figured it out…I’m just shocked to see you asked for comments on a topic near and dear to my heart!

  4. My rather lengthy response is here: