ARTICLENew Directions in Emergency Service Operations and PlanningZilm, Frank DArch, FAIA; Crane, Jody MD, MBA; Roche, Kevin T. PhDAuthor Information The University of Kansas School of Architecture, Design, and Planning, Lawrence (Dr Zilm); Emergency Services, Mary Washington Hospital, Fredericksburg, Virginia (Dr Crane); and Care Management, Banner Health Corporation, Phoenix, Arizona (Dr Roche). Correspondence: Frank Zilm, DArch, FAIA, The University of Kansas School of Architecture, Design, and Planning, 1401 W 50th Terrace, Kansas City, MO 64112 (email@example.com). Journal of Ambulatory Care Management: October/December 2010 - Volume 33 - Issue 4 - p 296-306 doi: 10.1097/JAC.0b013e3181f5343d Buy Metrics Abstract Emergency services continue to evolve new operational and facility concepts in response to increasing demand for care and pressures for efficient, and safe, patient management. This article describes new models for “intake” of patients and for responding to peak demand that are radically changing the traditional emergency service. Application of Six Sigma and “Lean” analysis techniques are demonstrating dramatic improvements in throughput times and in the utilization of treatment spaces. This article provides an overview of the application of Lean concepts to emergency services. Case studies of Mary Washington Hospital and Banner Health Corporation illustrate the result of application of these tools. Implication for the required patient care areas and design concepts are also discussed. © 2010 Lippincott Williams & Wilkins, Inc.