There is currently no basis to compare these numbers, but most emergency physicians realize that an ED with an unusually small footprint is noisy, is cramped, has relatively little privacy, and has little room for families. It is possible that sophisticated analysis would show that these EDs have higher infection rates, lower rates of staff satisfaction due to cramped workspaces and constant noise, and less need for sophisticated staff communication systems. EDs that have a very low number of visits per square foot need sophisticated staff communication systems, Segway transporters for the physicians, and monitor systems that will help patients or families not get lost.

Visits per patient care space is calculated by dividing the annual patient volume by the number of patient care spaces. The number of beds is often used as the number of patient care spaces, and in some states that is the number that is licensed. Because many EDs now designate spots for care that are not beds, the more useful term is patient care spaces. The definition will include all spots, including chairs and vertical treatment areas used routinely for patient care.

The ED cohorts average 1,350 to 1,750 visits per patient care space. The exception is pediatric EDs, which flow patients more quickly, resulting in about 1,800 visits per patient care space. Small EDs tend to have a relatively smaller number of patients seen per care space. Those EDs that have high numbers of visits per bed generally have higher walkaway rates. For full-service EDs that saw more than 1,900 visits per space, the walkaway rate jumps.

Note that many people were in hospital administrator school when the visit rates were reported at 2,000 patient encounters per bed. There are many hospital CEOs who will insist that the ED should be built to those visit rates because that is a known fact. Like many other “facts” about the ED, this one is wrong.

There are many areas that now design their space and process to essentially eliminate triage process and space. These new processes use a greeting model that is expanded beyond traditional nurse-based triage, including initial treatment decision-making. In EDs over 40,000 volume, there is a growing use of team triage models, which feature emergency physicians or advanced practice providers (APPs). The higher the volume, the more likely it is that the ED is using either physicians or APPs in the greeting model.