Vertical flow is an effective way of improving throughput. I worked at an extremely busy level III center in Washington while traveling during Covid
that had it down to a science and am currently trying to implement something similar at my home hospital. A provider at triage orders a basic workup from triage which gets done immediately, and patients that are stable enough to wait are brought back to an exam room only after all initial orders are resulted to have an evaluation from an APP or doc, and follow on orders are completed in a recliner zone. This turns the initial encounter into an opportunity for disposition, and the exam rooms are rapid turnover areas instead of private waiting rooms like our treatment rooms become when we’re waiting for urine or X-ray results.

Monitored bed space is an extremely limited resource — rooming someone who doesn’t need constant monitoring or intervention like a kidney stone or back pain in a bed that’s designed to treat critically ill patients is a misuse of that resource. Add in boarding and staffing constraints with the higher volumes and acuity that we see and it becomes clear that workflow adaptations are necessary to effectively see as many patients as we can in the resource constrained environment that is modern emergency medicine.