Rethinking traditional emergency department design to improve flow and patient - staff satisfaction: A future proof design for 24 h operations

Emergency departments (EDs) face increasing pressure due to rising patient volumes, evolving care models, and limited physical space. EDs can be organized according to different structural and operational models. Some systems allocate patients based on specific pathologies, while others prioritize triage acuity levels, as commonly implemented in regions such as Scotland and Wales. A third model - predominantly used in the United States - organizes care delivery into “pods” that combine mixed pathologies and varying levels of acuity within the same unit. While this mixed pod-based model is widespread in the United States, it remains uncommon in most European emergency care settings. This article describes the redesign of the emergency department at AZ Oostende and evaluates the implementation of a modular, unit-based organizational model aimed at improving patient flow, workload distribution, and adaptability without major physical expansion. Following the 2025 centralization of all emergency services at AZ Oostende, the ED layout and operational model were redesigned. Traditional pathology-based zoning was replaced with three mixed-pathology care units staffed by decentralized, co-located teams. Multifunctional treatment rooms and real-time patient allocation were introduced to allow flexible capacity management during daily and seasonal fluctuations in demand. Early observations indicate improvements in operational performance, including shorter patient throughput times, reduced crowding scores, higher staff and patient satisfaction, and more balanced staff workloads. By integrating architectural redesign with operational changes, the new modular ED model provides a resilient and adaptable framework for emergency care. This approach improves patient flow, team collaboration, and capacity management while maintaining continuous 24-hour operations and may serve as a future-oriented template for European emergency departments.