Hospitals are losing their usual pressure valves for crowded emergency departments. A third state recently banned ambulance diversion over ED overcrowding, joining Massachusetts, which has barred the practice for 17 years. At the same time, layoffs, called-off deals and thin margins make new construction a hard sell.
Some systems are finding capacity without building it. Here are six ways hospitals have done it, what each achieved and what it took instead of new beds.
1. Decide who actually needs a bed
Not every ED patient needs to lie down. Researchers from Mayo Clinic in Rochester, Minn., Harvard University in Cambridge, Mass., and Oxford University in England built a decision tool to determine which patients can be treated while seated. They tested it at Mayo Clinic Arizona’s ED in Phoenix. The authors noted that these decisions are typically made “in an ad-hoc fashion.”
Length of stay fell 4.2%, or 11 minutes, with no harm to quality of care or patient outcomes, according to the study, published July 9 in Management Science. The pathway cost nothing to implement because it used existing space and clinicians.
2. Move psychiatric crisis care out of the main ED
EmPATH units (Emergency Psychiatric Assessment, Treatment and Healing) give patients in a mental health or substance use crisis a calmer space, separate from the ED, where they can be stabilized and often discharged without an inpatient admission.
- At Charleston, S.C.-based MUSC Health, which now runs seven EmPATH units across South Carolina, average ED stays for behavioral health patients fell from 20-22 hours to 12-13 hours.
- At UK HealthCare in Lexington, Ky., ED boarding time linked to the unit dropped more than 92%. Inpatient psychiatric admissions fell 63.5% in the unit’s first year, and attendance at follow-up appointments rose from 29% to 65%.
These units require dedicated space, round-the-clock psychiatric staffing and peer support specialists. Payment is a concern, however: MUSC leaders said the Medicaid rate of about $400 a day after the first 24 hours is not enough to guarantee long-term sustainability.
3. Prevent the visit
Dallas-based Children’s Health cut ED visits and inpatient admissions 70% over two years through its 25-year-old asthma management program, according to the Children’s Hospital Association.
Families enrolled in the program get telehealth visits, education and care coordination. Certified asthma educators review each child’s action plan and inhaler technique, and virtual home assessments identify triggers. The program also trains school nurses and runs community education. Staffing it requires a multidisciplinary team of respiratory therapists, nurses, social workers and asthma educators, plus a separate high-risk team.
4. Lease beds at nearby nursing facilities
Several systems lease skilled nursing facility beds so patients who no longer need acute care do not occupy hospital beds while waiting for placement.
- Denver Health has leased beds since 2012. It cut patients with stays of 30 days or longer by 50%, which, combined with its guardianship program, effectively opened 10% of its acute care beds.
- WellSpan Health (York, Pa.) saves more than 5,500 acute care bed days a year through its Omega Bed Program, which serves more than 200 patients annually.
- Santa Clara Valley Medical Center (San Jose, Calif.) expanded its leased beds from 15 to 45 and cut non-acute hospital days by more than 5,000 a year.
UCI Health in Orange, Calif., Allegheny Health Network in Pittsburgh, Cone Health in Greensboro, N.C., and Harborview Medical Center in Seattle also lease beds. Making these programs work takes partner facilities, hospital physicians and case managers working inside them, and in some cases, paying for patients who lack benefits.
5. Convert existing space into transitional care
Northwell Mather Hospital in Port Jefferson, N.Y., runs a 16-bed transitional care unit in its former pediatric wing. The unit serves patients whose cases are too complex to go home but may not need a skilled nursing facility.
The average length of stay is about 13 days, and 86% of patients go home. The readmission rate dropped from 25% in 2017 to 7% in 2026. Patients average 83 years old.
The catch is licensing. The unit requires a separate operating license, and New York no longer issues them; only five such units remain in the state.
6. Remove the waiting inside the ED
Some hospitals are recovering capacity by redesigning how the ED works.
- Montefiore Einstein in New York City changed what leaders call “hurry-up-and-wait” delays. It also added daily huddles where data scientists and physician, nurse and advanced practice provider leaders review the previous day’s stress points. Its left-without-being-seen rate is below 1% so far this year.
- Banner Estrella Medical Center in Phoenix redesigned ED processes to speed first clinical contact and start diagnostics earlier. In 2025, the share of patients leaving without treatment fell to nearly 1%.
- Piedmont Athens Regional Medical Center in Georgia uses a nurse-led EMS triage process during high-volume periods to transfer patients and return ambulances to service within the state’s 20-minute benchmark.
The tradeoff
None of these fixes requires construction, but each has its own limits. EmPATH units depend on payment rates. Transitional care units depend on licenses. Leased beds depend on partner quality, and for some patients on Medicaid approvals that can take months. Workflow redesigns depend on sustained leadership attention.
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