More space for the ED would definitely be helpful, but is likely not the entire answer. Much like traffic congestion which doesn’t improve when extra lanes are added to highways,¹ ED overcrowding is unlikely to be solved by just increasing space. In fact, a study conducted at an academic medical center that expanded its ED bed capacity found no significant change in the percentage of patients who LWBT, but was instead associated with increased ED boarding hours.² Although the number of ED beds may not be a critical target for ED improvement, careful design and use of ED space is critical for providing the best patient, staff, and provider experiences. Thoughtful ED design can help enhance flow, maximize efficiency, and allow for flexibility to accommodate for variations as different needs arise.³

Another important consideration in regard to potential ED expansion is ongoing shortages of clinical team members, primarily nurses.⁴ Nursing is facing significant shortages nationwide, and even under the best conditions, the ED is a unique and often stressful work environment. With persistent overcrowding and increased violence in the healthcare setting, the ED has become an even more difficult work setting, and strategies for hiring and retention of ED nurses is a critical piece to maintaining a highly functioning ED.⁵

References:

1. Increasing Highway Capacity Unlikely to Relieve Traffic Congestion (https://dot.ca.gov/-/media/dot-media/programs/research-innovation-system-information/documents/final-reports/10-12-2015-ncst_brief_inducedtravel_cs6_v3.pdf)
2. Mumma BE, McCue JY, Li CS, Holmes JF. Effects of emergency department expansion on emergency department patient flow. Acad Emerg Med. 2014 May;21(5):504-9.
3. Marshall KD, Imhoff B, Zilm F. Design of the Academic Emergency Department. Emerg Med Clin North Am. 2020 Aug;38(3):617-631.
4. Ramsey Z, Palter JS, Hardwick J, Moskoff J, Christian EL, Bailitz J. Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics.
5. Amarrador A, Crilly Oam J, Brough P, Elder E. Interventions to retain emergency department nurses: A scoping review. Int Emerg Nurs. 2025 Mar;79:101573.