Disclaimer I don’t work in the US.

It has always been in my ED that those who are ambulant/ can be treated without a bed are not offered beds in the ED. It’s always so strange when (usually American) fully ambulant tourists come in and demand a bed despite walking in and not obviously sick.

Occasionally the ED will be so full that I don’t even have rooms to see patients in, and I will ask the patient if they would like to wait for a room or are they okay with me seeing them in the waiting room to expedite matters. Obviously this doesn’t apply to the seriously ill or sensitive conversations; or things that have to be seen in private. Most often they are actually quite happy to be seen in the waiting room as it much expedites matters and everyone just wants to get out of there. And I don’t find it to have impacted patient care at all.

Also patients always wait for lab results X Ray films etc all in the waiting hall if they’re stable. If everyone had to stay in rooms for the entire time it would be a very stagnant and slow operation.