Marilyn McCullum Emergency department staff nurse IV, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa CA, US
Why you should read this article:
• To find out how patient flow has been reimagined in an emergency department (ED) in California
• To think about different ways of using the physical space in an ED that may help improve its throughput
• To consider the benefits of decoupling diagnostic tests from bed availability for avoiding delays in the ED
Emergency departments (EDs) face ongoing challenges such as overcrowding, long waiting times and patient dissatisfaction. Traditional triage-to-bed models of ED care tend to delay diagnostic tests and treatment for moderate-acuity and low-acuity patients. This article describes the redesign of patient flow in one ED in California, in the US, through the creation of portal rooms for early diagnostic tests and QuickPass rooms for low-acuity encounters, with the goal of reducing delays and improving throughput. Early feedback from patients and staff was positive, including improved patient perceptions of receiving timely care. The use of portal rooms and QuickPass rooms represents a practical, low-cost strategy for addressing overcrowding. While formal outcome data are needed, this initiative highlights how lean, resource-conscious ED redesign can meaningfully address long-standing challenges in emergency care. By redefining the use of their physical space and initiating diagnostic tests earlier, EDs can improve patient experience and staff efficiency.
Emergency Nurse.
doi: 10.7748/en.2026.e2249
Peer review
This article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence
Conflict of interest
None declared
McCullum M (2026) Redesigning emergency department processes: a nurse-led, portal-based flow model to optimise resource use and patient care. Emergency Nurse. doi: 10.7748/en.2026.e2249
Published online: 24 February 2026
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