Spatial Configuration and Emergency Department Performance: A Review of Space Syntax Applications

Emergency departments (EDs) operate under high-pressure and time-critical conditions in which spatial configuration plays a fundamental role in shaping workflow efficiency, staff coordination, and patient experience. Although Space Syntax has been increasingly applied in healthcare environments, evidence relating specifically to ED design remains fragmented, with inconsistencies in methodological approaches, performance interpretation, and operational linkage. This study presents a structured review informed by PRISMA 2020 guidelines to synthesise peer-reviewed research published between 1990 and 2025 on the application of Space Syntax in emergency department design, resulting in 14 eligible studies. The synthesis identifies three recurring thematic domains: spatial configuration, visibility and visual connectivity, and functional adjacency. The findings indicate that spatial integration, connectivity, and visibility conditions are consistently associated with circulation efficiency, supervision capacity, and workflow continuity. However, methodological heterogeneity, particularly in spatial representation, radius selection, and validation practices, limits cross-study comparability and predictive inference. To address these limitations, this review offers an integrated conceptual synthesis of existing evidence concerning the relationships between spatial configuration, visibility, and functional adjacency in emergency department environments. The synthesis suggests that relationships between spatial configuration, visibility, and functional adjacency may be interpreted as interconnected influences on emergency department performance. Overall, this review positions Space Syntax as a configurational performance evaluation methodology rather than a predictive tool, while highlighting the need for future research to integrate spatial analysis with simulation modelling, behavioural validation, and real-world operational data to enhance applicability in high-demand emergency environments.