Incorporating a local nature themed palette, we tackled the goal of creating an enhanced and expanded state-of-the-art emergency department. HCA Mountain Star required complete demolition of the existing Emergency Department and adjacent physical therapy treatment space, doubling the size of emergency services to 10,000 square feet. The expanded department has 10 exam/treatment rooms and 2 trauma rooms located around an enlarged central nurse station, improving visibility and access to each patient room. The exam rooms are organized around the concept of efficient staff use and reduction of visual clutter by creating custom millwork to conceal the headwall when not in use. Two of the exam rooms can also be used as psychiatric holding rooms. In addition to the main emergency treatment area, there is a Fast Track zone with triage space and two exam rooms, a new bereavement and consult room for family use, and greatly improved staff and support spaces.