This project transformed the Lutheran Hospital Emergency Department into one that meets the standards of today’s emergency care and patient expectations. The Owner’s approach to project delivery at this facility was modified because previous projects did not meet their budget nor were complete on time, resulting in large change order amounts. Both budget and physical space were limited for this project so the OCTPD method was employed to achieve better outcomes. The team completed the project ahead of schedule and under budget. Lutheran Hospital is currently a Behavioral Health Regional Center, requiring emergency intake rooms for this patient type. The emergency room layout and flow is designed to reflect the set ups of the other regional ED’s within a floor plate restricted by several existing conditions. The Cleveland Clinic aesthetic brand had been extended to this facility in a commitment to provide excellent healthcare services to the neighborhood.