Northern Arizona Healthcare (NAH) is planning a renovation of the emergency department at Flagstaff Medical Center (FMC) as a temporary solution to reduce wait times and expand capacity as it continues to develop long-term plans for the hospital.
Work on the renovation is expected to begin Monday, June 2, and continue in phases through January 2026. Hospital leaders have said the emergency department will continue to treat patients as construction is underway and they have developed contingency plans to handle unexpected surges in volume.
Davey Ellison, system director for emergency and trauma service line at NAH, said the goal is for this renovation to reduce the average wait time by an hour for every patient visiting FMC鈥檚 emergency department (ED), and to bring the percentage of patients leaving without treatment due to the wait time to under 1% in a way that can be sustained.
The percentage leaving before being seen has been falling in recent years -- it was 6% in 2022, 5% in 2023 and 3% in 2024. Ellison and Rachel Levitan, NAH's interim chief medical officer and ER physician, noted that the national average is over 2%, with some departments having a rate higher than 10%.
The average wait time at the hospital was less than an hour on May 23, with peak wait times this year rising to three hours. The NAH leaders said that previously, peak times could involve a wait between five and six hours.
The second phase of construction is expected to start July 8, and a section of the ED will be closed for the 30 weeks it is in progress.
鈥淚f we do see a surge in patients coming in that we didn't anticipate ... [the] goal is to be proactive and address that immediately," Ellison said. "We have a couple plans for surging. 鈥� It might happen, but we think we have a good plan to address it."
鈥淲e have backup plans to backup plans,鈥� Levitan added. 鈥淚 think the thing we anticipate the most beyond the obvious [signs of construction] ... is we may need to ask our patients in our community to have some flexibility. They may get moved around a little bit from one spot to the other as we do different parts of their care, but we鈥檙e going to make it as smooth and seamless as possible.鈥�
Planned renovation
The hospital will be adding a treatment area for patients who don鈥檛 need the full set of medical equipment included in most ED rooms. It will be its own functional area within the department and can treat up to seven patients at a time, with separate testing stations, and will be located near any shared equipment that might be necessary. Staff will also be able to move patients between the two areas if their needs change.
This is intended to improve the workflow by sorting patients based on their needs and freeing up other areas for those needing the specialized equipment inside of them.
鈥淚t will allow us to get the testing done much quicker and decision-making to be much quicker and allows us to get those people through the system and a small extra area to see them in,鈥� Ellison said.
A patient who needs stitches for a cut on their leg won鈥檛 need the equipment for cardiac monitoring or resuscitation, Levitan said as an example.
This patient would have a shorter wait time to be seen in one of the new areas created by the renovation and would free up a space with that equipment for another patient whose treatment requires it -- reducing their wait time as well.
The space for this new area will be created by moving the administrative spaces currently in the department.
The renovation will also include paint, flooring, and lighting updates to help with infection prevention and to meet the goals in the White House Sustainability Pledge that NAH signed in 2022.听
A short-term solution
This is not intended as a replacement for NAH鈥檚 plans to replace FMC with a new hospital building in a different location.
Those proposals were first announced in 2021 and included a new hospital, ambulatory care center and surrounding health and wellness village on property owned by the healthcare system next to Fort Tuthill County Park. NAH has been developing an alternative to its original plan following a referendum in 2023, when over 70% Flagstaff voted against Proposition 480聽on the city's approval of rezoning for the project.
鈥淲e know that to keep serving our community and our community in the future, we need a bigger modern hospital,鈥� Levitan said. 鈥淭his is a, 鈥楬ey, we can鈥檛 wait until that happens. We need this now to take care of our community.鈥� That鈥檚 why we鈥檙e doing this now, because we have such a need.鈥�
As of May 23, FMC's emergency department was on track to see 48,000 patients in 2025 -- an increase from 2024.
The department averages 131 visits a day.听
NAH's press release outlined the reasons the renovation is not intended to be a substitute for building a hospital in a new location.
The new hospital plans include 42 ED exam rooms, two trauma rooms and three triage rooms, according to the release, which also said these cannot be added to the current space as part of this renovation.
The renovation is an "stop-gap measure to improve efficiency and patient services," it said, and does not add square footage.
"Because of space limitations at the current hospital site, including structural limits, the inability to reduce the size of other departments and the need to maintain the limited parking availability, we will not be able to add square footage to the ED during this project," it said. "Redesigning the patient flow is our only option to improve service."
A NAH spokesperson said there have been no updates on its search for a new location since January, when CEO Dave Cheney said the search had been narrowed to four unspecified options, with the goal of selecting a final site by the end of the year.
Over capacity
Levitan and Ellison said they believed a new and larger hospital would be needed to address the FMC emergency department鈥檚 capacity issues in the long term.
The renovation is intended to be a temporary solution; Ellison said he expected it would work for somewhere between two to four years, provided the area鈥檚 population continues to grow at a similar rate to previous years. By the end of this time, he said, the hope is for NAH to have figured out the next step for providing care in Flagstaff that includes a longer-term solution.
They also both said the renovation is necessary, as the number of patients visiting FMC has increased in recent years.
NAH first started looking at potential solutions in early 2024 and tested this on a smaller scale midway through the year. The board approved the plans the first time they were brought forward in early 2025.
The project will be funded through one-time NAH funding approved by the board. The healthcare system declined to say how much it will cost.
"It's important for the community to know the structure as a nonprofit healthcare system, in that we reinvest our funds in the community," they wrote in a later email. "This renovation is an example of spending to expand services to meet the needs of a growing region."
FMC performed a test of change starting in October to learn more about the potential effects of completing this renovation. That test showed a decrease in patients who left without being seen as well as in the overall wait time, Ellison said.
鈥淚 think with this trial we did, the test of change on a smaller scale, it really brought to light for us how much our space constraints make it hard to get patients through their ED and get them their treatment in the timely way we want to,鈥� Levitan said. 鈥淭his will help with that, but it鈥檚 not enough of a solution for what we need ... as the community continues to grow and expand. We are not going to get fewer ED visits, we only get more and more visits every year. We just need a lot more space.鈥�
Levitan said Flagstaff鈥檚 increased wait times and reduced capacity are part of a national trend, with 鈥渙vercrowded鈥� hospitals leading to patients who are ready to be admitted waiting in the ED for an inpatient space to become available. They also noted the country's aging population.
鈥淚t has just exploded in the country鈥� in recent years, she said, with Ellison adding that FMC has seen an increase in people seeking care. They noted that the hospital serves not only the city, but the larger region of northern Arizona.
鈥淲e are at hospital capacity a lot -- way more than we ever were 10 years ago,鈥� Levitan said. 鈥淎lmost every day we鈥檙e at capacity, so we just don鈥檛 have anywhere to put these patients.鈥�
Increasing efficiency
The hospital has already been making changes to its ED operations in an effort to make throughput more efficient. Both the hospital and healthcare system have also hired additional staff to aid these efforts.
FMC employs a total of 130 staff in its ED and uses 41 daily.
Ellison explained that the hospital measured the time it takes to complete each step a patient typically goes through during a visit to the ED -- how long it takes to see the physician, draw labs, or have specimens or different types of imaging returned, for example.
These are all factors ED staff use to determine whether the patient will need to be admitted, kept for observation or discharged with follow-up.
Department staff then worked to find ways to reduce the time needed for these steps, as well as any other factors in other parts of the hospital that could have an effect. There are monthly meetings to go over this data, he said.
To maintain quality of care when doing so, Ellison said NAH has assigned a charge nurse at each of its campuses to spend at least half their time monitoring six to seven metrics.
Any problems lead to immediate recurring meetings with staff involved.
鈥淲e are obsessed with safety,鈥� Levitan said, noting that hospital staff and their families also receive care from FMC. She and Ellison also pointed to the hospital鈥檚 A safety grade from The Leapfrog Group -- which it has received in twice-yearly reviews since fall 2023.
Every patient moving through the ED is given a patient satisfaction survey. According to Ellison, the most common negative result in that was the wait times and that they鈥檇 already seen improved survey results with the test of change.
More about NAH's plans for development in Flagstaff can be found at聽.