PIMS Islamabad Main is the primary healthcare provider in the region. The new standalone emergency department with 172 beds will serve the hundreds of patients that present daily. Fast track and short stay beds are positioned on the ground floor with a large waiting and reception area adjacent to public entry. Ambulance entry leads to trauma rooms, imaging, diagnostics, decontamination and secured holding. Extended stay beds in observation units are on the upper floor which connect to the main facility via a pedestrian bridge. The team was challenged to design operational efficiencies to deal with the extraordinary case load. LEAN principles were applied to operations, including modular design for off-site assembly, and prefabricated exterior building components to accelerate construction.