Emergency Department design is driven by looking at the maximum volume to be expected. However, for a significant part of each day, the number of patients presenting to the ED are but a fraction of the peak. During these periods, generally, between 11:00PM and 8:00AM, staffing is at a minimum. Generally, volume increases incrementally and ideally, staffing would keep pace with this change. However, during low census times, there are frequent occurrences when one, two or three more patients arrive than staff have planned for. Many times these patients can be managed by the minimum staff, if they [staff] could keep an eye on the patients in their rooms. However, many ED's are planned in such a way that when that one more patient arrives, an additional staff member must be added in order to see and care for said patient. These instances drive up costs of care, as there becomes an inefficient ratio of staff per patient.

This presentation illustrates the "Ribbon" design for the Emergency Department. The "Ribbon" or continuous, closed loop layout of exam rooms can keep operating costs in line. It permits a minimal staff to effectively manage a few more patients for a short period or until additional staff needed.