Explore strategies for optimizing emergency department operations in this comprehensive lecture from the 32nd Annual EM & Acute Care Course. Delve into a wide range of topics including staffing flexibility, psychiatric care, patient flow, and interdepartmental collaboration. Learn about innovative approaches such as flexible scheduling, partnership longboarding, and the use of pet teams. Examine the challenges of behavioral and adolescent psychiatry, suicide prevention, and managing undifferentiated agitation. Discover techniques for improving efficiency, including streamlining admission processes, managing overcrowding, and optimizing lab repetitions. Gain insights into legal considerations, pressure management, and the role of various healthcare professionals in emergency care. Drawing from the Emergency Medical Abstracts database and faculty expertise, this presentation offers specific recommendations for enhancing diagnosis and therapy in emergency medicine.