A Simple, Free Fix Is Helping ERs Save Time Without Adding a Single Bed

Bed shortages are one of the most persistent bottlenecks in emergency departments, but a new study suggests hospitals may not need more beds at all — just a better way to figure out who actually needs one. Research published in the journal Management Science found that a simple decision-making tool can help ER staff identify patients who can be treated sitting up, rather than lying in a bed, freeing up capacity without compromising care. The researchers built a decision tree, developed using mathematical and machine learning models, to guide staff toward what's known as a "vertical processing pathway" — a treatment space many hospitals already have but often use inconsistently. The team tested the protocol at Mayo Clinic Arizona's emergency department, comparing it against the hospital's usual ad hoc approach. The result: an average reduction of about 11 minutes per patient stay, with no increase in patients returning within 72 hours. Study co-author Agni Orfanoudaki, an associate professor of operations management at the University of Oxford's Saïd Business School, spoke with U.S. News about the findings and what other hospitals could learn from them. The conversation has been edited for length and clarity. Why does this simple change have such an outsized impact on emergency departments? According to Orfanoudaki, bed availability — not physician capacity — is typically the real bottleneck behind ER wait times. The study's core idea was to ask whether patients could be examined without a bed at all. By setting up a small space equipped with little more than a chair, hospitals can create an alternative pathway for eligible patients. She noted the approach is inexpensive to implement, since it doesn't require added capacity or new staff — essentially a workaround using existing resources. What kinds of situations call for vertical treatment? Eligibility isn't simply about how severe a patient's condition is. Orfanoudaki gave the example of a patient having a serious allergic reaction — they need immediate attention, but not necessarily a bed to stabilize. By contrast, a patient with alcohol intoxication would likely need an IV, making the vertical pathway impractical for them. An 11-minute reduction doesn't sound dramatic. Why does it matter for a health system? Orfanoudaki said past efforts to reduce ER wait times by adding beds or clinicians have sometimes backfired, since improved performance can draw a higher volume of patients — something Mayo Clinic had experienced before. What stood out to the research team was that this protocol required no financial investment yet still improved efficiency, to the point that Mayo Clinic's central operations team reached out to ask what the ER had changed after noticing faster patient throughput. Where should a hospital administrator start if they wanted to implement this tomorrow? Orfanoudaki said hospitals need a designated space for the vertical pathway and should follow the study's decision protocol, which relies on a maximum of five questions nurses can ask during triage. She said the tool was designed to be adaptable across different hospital settings. Are there broader lessons here for improving healthcare efficiency? Orfanoudaki said the study reinforces that complex, high-tech solutions aren't always necessary to see meaningful gains — a simpler approach that captures most of the benefit can be enough. Given the high-stakes nature of medical care and the number of people involved in each decision, she said any process improvement needs to guarantee patient safety without compromise.