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From Bottleneck to Breakthrough

October 28, 2025
Melissa Laatsch, EDAC Avatar
Melissa Laatsch, EDAC
Senior Interior Designer

Behavioral Health Design – An Emergency Department Operational Imperative

Part Two

The emergency department has become an unavoidable front line in the behavioral health crisis.

Patients in acute distress often arrive via law enforcement, EMS, family, or in some cases on their own. And when they arrive, many present having abused substances, under the influence, are medically complex, and without a clear next step for care.

Many emergency departments (EDs) are not built to manage this complex new reality. Behavioral health patients can remain in the ED not for hours, but for days, creating bottlenecks that ripple across the department and strain clinical teams. For hospital leaders, the question is no longer if design matters in ED behavioral health, it is how design can relieve pressure, restore flow, and support both patients and providers.

Where Flow Breaks Down & How to Fix It

Looking through the lens of the patient journey, it becomes clear where ED environments succeed and where they create risk. Each phase, from arrival through discharge or transfer, presents critical moments that require operational alignment and design response.

Emergency Department Journey Map

This journey-based view grounds design in clinical reality. It also frames behavioral health not as a side function of the ED, but as an integrated operational strategy.

Behavioral Health: Bottleneck in ED Throughput

The most common friction point is flow. Behavioral health patients cannot always be triaged or discharged quickly. If not managed well, their presence disrupts throughput for the entire ED.

Design addresses the behavioral health population’s needs by providing safe staging zones for arrival, flexible triage spaces with visibility, and crisis units located adjacent to, yet not within the main ED. Privacy and zoned behavioral health rooms preserve the patients’ dignity while preventing the disruption of the broader departmental acute care patient population. Spaces equipped for extended stays with access to circadian lighting, acoustic control, and safe comfortable furnishings support stabilization, without compromising throughput.

This emergency department incorporates a dedicated crisis unit separated from the main department by a secure partition and door. This zoning preserves dignity, limits disruption, and allows for dedicated staff and rapid access. Located just off the ambulance’s entry, the unit enables direct EMS transfer into a safe, controlled space, reducing congestion in the main ED and improving throughput. Flexible hold rooms nearby provide added adaptability during patient surges, supporting smoother triage and stabilization.

Leveraging Data to Right-Size the Emergency Department

  • Designing for behavioral health is not simply about creating space, it is about aligning space with projected volumes and capacity. Projected volumes and acuity help determine the right allocation of crisis unit rooms, observation zones, and staff support spaces.
  • Leveraging psychographic data like substance use trends, repeat utilization, and community profiles guides the creation of environments that are responsive and relevant to real patient needs.
  • With current length of stay patterns, spaces originally designed for 24 to 48 hours must be adaptable to support patient stays that extend four to five days.
Psychographic and data analysis transform design from assumption-driven to strategy-driven, allowing hospitals to create environments calibrated for safety, streamlined flow, and operational efficiency.

Design for Flexibility: Acuity Adaptation

Example of one exam room that adapts to different care levels—ensuring staff deliver the right care in the right setting while enhancing efficiency, safety, and experience.

Design as Strategy: Unlocking ED Capacity

Behavioral health patients are often the tipping point for emergency department overcrowding. When these patients cannot be triaged, stabilized, or discharged quickly, they occupy valuable capacity for days at a time, creating downstream impacts  throughout the department. Purposeful design can transform this challenge from a chronic bottleneck into a manageable, strategic function of the ED. Effective environments address the full patient journey:
  • Arrival and Triage: Safe staging zones and flexible triage spaces with clear sightlines allow staff to assess and manage patients quickly, while maintaining safety.
  • Crisis Units: Locating dedicated units adjacent to—but separate from—the ED core preserves throughput while providing space for observation and care without disrupting the broader patient population.
  • Room Design: Private, dignified rooms equipped with circadian lighting, acoustic control, and safe, comfortable furnishings support stabilization and extended stays of multiple days when needed.
A design strategy must also acknowledge the whole person. Patients in behavioral health crisis often carry complex medical and social needs. Environments that integrate psychological, medical, and social supports, not only protect patient dignity, but also create conditions for faster stabilization.

These same strategies benefit staff. Layouts that provide visibility, flexible observation zones, and technology integration reduce burnout, improve safety, and strengthen care team performance. When environments are purpose-built for behavioral health, the ED functions as an integrated system rather than a stopgap for patients in crisis.

The Business Case for Behavioral Health Design

Behavioral health patients are not just a clinical reality in the ED; they are an operational driver. Without purpose-built environments, hospitals face unnecessary costs, higher risk, and staff burnout.

Janet Lively McCauley, CPSM, Associate AIA

Vice President, Healthcare
+1 608.410.8000

Take the Next Step

Contact ERDMAN today to learn how our expertise can help you develop a successful behavioral health facility that meets the needs of your community and supports your organization’s goals for sustainable growth.

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