Built environment design to support the Emergency Department system, staff and patient outcomes: a systematic literature review

The design and use of the built environment (BE) in emergency department (ED) settings can influence system performance and experience of patients, families, and staff, and has been widely investigated in the field of evidence-based design. However, a wider and integrated approach to exploring how the ED BE influences the performance and outcomes of the system and its users is lacking. This review synthesises literature describing how the ED BE has been designed and analysed to support the four outcome measures important in healthcare–system performance, staff experience, patient outcomes, and patient experience. We followed the PRISMA guidelines to select relevant publications. Four databases were searched, i.e. PubMed, Scopus, Web of Science, and Ovid (last search in July 2025), which resulted in 71 double-reviewed records included. Content analysis of included studies was conducted using the four outcome measures as a heuristic device, with inductive BE categories and ED spaces emerging from the publications. Findings consist of 169 design prescriptions of BE strategies presented according to 12 design principles, the four outcomes and five categories of spaces. This review provides a useful reference to the principles described in the extant literature and can be leveraged to facilitate discussion of local priorities. The design principles associated with more outcomes are: safety and security measures, patient flow and care models, accessibility and mobility, technology integration, and sensory-friendly environments. To our knowledge, this paper is the first to extensively review BE attributes with a broad range of ED outcome measures. PROSPERO registration number: CRD42024575408.