## 3 Results
### Literature Review
#### 3.1.2 The Functional Layout  
The functional layout includes the internal communication system, internal connectivity and connections to other departments of the hospital as well as the provision of isolated areas of the branch and functional zoning.  
The sequence of these steps determines the spatial location of the necessary rooms and areas (room units) and the access path to reach them. The'sequence of events' takes its origins in the system or from the technological requirements. In most cases, the adoption of a suitable framework for the processes strongly narrows the room for designer's maneuver, though (especially in the case of American FSD solutions) the whole range of possibilities is allowed--this is why the American Free Standing Emergency Department can be designed with more flexibility.  
The layout of an ED can have a crucial impact on patients that pass through it, for example, from the acoustic point of view [34; 43]. Furthermore, the localization of specific parts of the structure can provide a significant role in the management and number of staff, and decrease the average waiting time of patients [3; 9; 37; 38].  
The enhancement of ED design helps nurses and physicians to benefit from supportive environments. A study has shown that an efficient placement of the clinical units yields remarkable improvements in the distances traveled by patients [30].  
In the case of the HBED, the functional arrangement can be described as a 'functional passage', i.e., all the basic ED elements are arranged on the axis of internal communication, connecting the triage area to the hospital access, which is a one-way flow of patients, from the processing admission area, through the triage area, treatment areas (therapy and observation) to the hospital. The sequence allows the separation of several zones dedicated to various medical procedures, according to the identified potential life risk. The flow of patients through targeted areas (i.e., as follows: resuscitation/observation/intensive care/operating suite/hospital bed ward) makes it possible to filter them out.  
The American model has a slightly different approach: as the central system, with combined therapy and observation area (treatment area/cubicles) located in the inner hub supported by an extensive nurse station. Other areas of the department are in the radial arrangement in relation to the central zone. Such organization of the patients' flow forces all the movement towards the center, without any significant diversity in the relevance of the ED zones. However, unlike HBEDs, the FSEDs:  
* Lack trauma level verification by the American College of Surgeons;
* Do not receive patients via ambulance diversion or transfer;
* Do not have overnight beds or intensive care capabilities (mostly);
* Lack inpatient referral or admissions capabilities; and
* Do not have the resources to deal with large influxes of patients from natural and/or man-made disasters.  
Considering the fact that there are numerous acceptable variants of the solution: changes in the geometry of the layout, variants of the communication axes, etc.; the diagram (Figure 5) represents a possible functional model and would mostly change in its composition with different settings, but the organizational structure remains almost the same.  
Furthermore, the shape of spaces has a crucial role in terms of the efficiency of spaces and it emerged that rectangular areas must be preferred [41].  
According to [PERSON] et al., during the first wave of the COVID-19 pandemic, all EDs adapted, but many of the changes such as the creation of different paths and access recommended for the organization of ED could not be implemented. That is due to the ED architecture constraining adaptive capacities as the flexibility of spaces was not provided in the project preliminary phases [42; 45].