It’s 10:42 a.m. and the emergency department already looks like an overbooked flight. Every waiting room chair is full, people are standing along the walls, and the triage nurse just flagged you about a patient whose O2 sat is hovering in the mid-80s. Welcome to the new normal in emergency medicine.
Across the country, EDs are facing unprecedented volumes. We’re boarding more patients for longer, and that seasonal surge we used to brace for? It’s become a year-round reality. In this setting, "lobby medicine" isn’t just a buzzword—it’s a survival strategy.
Ten years ago, treating patients from the waiting room would’ve sounded reckless. Now, it’s a calculated strategy. Lobby medicine—evaluating, treating, and even discharging low-acuity patients from the waiting area—can reduce wait times, increase throughput, and keep the ED from collapsing under pressure. And no, it’s not cutting corners. It’s meeting patients where they are (literally) and not letting the constraints of a full department become a barrier to care.
A Real Strategy, Not a Shortcut
Patients come to the ED to be seen. Lobby medicine helps us honor that intention faster. It can speed up time-to-provider, reduce length of stay for ESI 3–5 patients, offer a second safety net triage screen, and improve flow metrics (because, like it or not, they’re not going anywhere). Done right, lobby medicine allows clinicians to offload lower-acuity cases and keep the department from buckling under pressure.
Implementing this strategy takes more than just good intentions. It requires planning, collaboration, and a shift in mindset. Here’s what helps:
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▪️Start with Clear Criteria: Not every patient belongs in the lobby workflow. ESI 3, 4, and 5? Often great candidates. Suspected sepsis, unstable vitals, or anything that gives you that uneasy feeling? They need a room. Set guardrails, communicate them clearly, and revisit them often.
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▪️Reallocate Strategically: Taking away one room and one nurse to staff the lobby can improve throughput for everyone. It’s a delicate balance—one that depends on your team’s bandwidth, layout, and volume. But redistributing resources with intention is key.
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▪️Set Up Your Space: Make sure there’s adequate spacing for privacy and infection control (ideally four waiting room chairs per patient: one for the patient, one for a visitor, and one on each side for spacing). Equip your lobby with grab-and-go supplies, think BP cuffs, pulse ox, suture kits, and quick meds. The fewer trips back to the main ED, the better.
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▪️Get Buy-In: From nurses to lab techs to environmental services, everyone needs to be on board. This isn’t “extra work.” It’s an opportunity to provide timely care to people who would otherwise be waiting– (and possibly deteriorating) in the lobby. Celebrate the wins. Acknowledge the challenges. Keep the mission front and center.
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Trade-Offs Are Part of the Deal
Let’s not sugarcoat it. Lobby medicine comes with trade-offs:
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▪️Privacy? Compromised. We do our best, but a waiting room will never be HIPAA-perfect.
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▪️Patient satisfaction? Mixed bag. Some will love the speed. Others will hate the setting.
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▪️Infection control? Challenging, especially during respiratory virus season.
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▪️Staff fatigue? Real. Don’t stretch your people thinner. Restructure your staffing to make it sustainable.
The goal is not perfection—it’s progress. And that progress means acknowledging the moment and doing what we can with what we have.
Lead With Transparency
If you’re feeling weird about it, chances are your patients are, too. So say something. A simple, “We’re seeing a high volume of patients right now, but I didn’t want you to wait any longer without being seen. Is it okay if we talk out here?” goes a long way.
Lobby medicine isn’t a failure. It’s a response to the reality we’re living in—a stopgap born out of necessity and care. It's not ideal. But it's also not beneath us. These are still our patients. This is still our work. And sometimes, meeting people in the lobby is exactly what medicine looks like.
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