To meet the increasing healthcare demands of a rapidly growing community, Alamance Regional Medical Center (ARMC) needed to upgrade its outdated emergency department (ED). Designed with resiliency in mind, the project involved the construction of a two level addition on the north side of the hospital in front of the existing ED, which accommodated new and expanded specializations. The project also included substantial renovations to the existing OR suite to minimize patient movement and increase patient outcomes, while simultaneously right sizing the renovated ORs to align with the service line needs.