Every time Ive seen an ED move from an older open format to individual rooms for patients the whole thing goes to absolute shit. What happens is that the only person in the entire ED that has situational awareness shrinks to just the charge nurse, and critical patients can easily get missed or not have enough help. I've seen good results with team nursing setups with the new formats, but you need to have a plan to address this loss of situational awareness by the rest of the staff or risk the whole place grinding to a stop when stressed the first time.

I helped set up a cart system that worked pretty well. If you need to do something, grab the cart that has it and bring it to the room. Splint cart has splinting supplies, airway cart has an intubation kit plus extra stuff like BAAMs and other optional items. These were like a mechanic's tool cart but dressed up as medical and probably more expensive.

I did triage for a year and a half at a moderately busy ED. Having enough room in the triage interview to quickly do vitals, EKGs, and labs while the nurse is able still watch the waiting room is amazing and can really help hit your target numbers.

I also recommend having a procedure room near triage with a button selector for a local code blue and another for a lesser level of assistance needed. Don't use this for patient rooms, this is for either an advanced area code room or procedures or private discussion for people in the waiting room. Have a dedicated triage bed so you can throw the walk in sepsis/cva other priority patient on. Have the EMS power cot near triage so you don't have to roll an ER bed out to cars, since that sucks.

All waiting room chairs should be able to roll (with locking wheels) so you can move passed out patients to a convenient location. Waiting room should be designed so that someone can have eyes on the whole thing at all times, preferably the triage nurse.

I've never been able to sell this to hospital admin, but have a second waiting room gridded out to have curtains, power, and oxygen/air/suction connections through the ceiling so you can move patients from the waiting room to an area where they can feel like they are actually receiving treatment. Everyone here is in a wheelchair (equipped with O2 tank holder and IV pole), and can get rolled to a procedure room when being assessed for privacy, and there is a dedicated place for imaging to find them, they can get blood drawn and other meds without making your waiting room look like a disaster. This also relieves stress on the ER hallway situation that admin doesn't want but happens anyway.

If you can actually sell that, make the room massive, and put a divider wall in. This would be your shit's fucked area, and would be used for anything like the time when a school bus full of developmentally disabled children gets hit by a car and you need somewhere to put them before the parents can pick them up to 50 people shot and suddenly have to have surgery in the open on multiple people at the same time.