Emergency medicine

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7360.389/a (Published 17 August 2002) Cite this as: BMJ 2002;325:389

Whole system is responsible for solving overcrowding of departments

  1. Matthew Cooke, Department of Health's accident and emergency adviser (m.w.cooke@warwick.ac.uk)
  1. University of Warwick, Coventry CV4 7AL
  2. Royal United Hospital, Bath BA1 3NG jerry.nolan@ukgateway.net
  3. Advanced Life Support Course Subcommittee
  4. Resuscitation Council, London WC1H 9JR
  5. Macarthur Health Service, PO Box 149, Campbelltown, New South Wales 2560
  6. Royal Perth Hospital, Perth, Western Australia 6000

    EDITOR—Fatovich highlights the important international problem of overcrowding in emergency departments, a common cause of this being the decreased availability of inpatients beds.1 The risk of waits is proportional to the average bed occupancy. In the United Kingdom it is now recognised that excessively high bed occupancy (over 85%2) is a sign not of efficient management but of failure to plan.

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    Fatovich suggests only two long term measures to address overcrowding. Although increasing the number of beds should decrease overcrowding, it has to be combined with a bed management system, working across elective and emergency components, to ensure that average bed occupancy is kept at 82-85% (this may require an extra 10 000 beds in England).

    Overcrowding in emergency departments can be solved only by measures across the whole health community. In the prehospital phase, systems must be in place to avoid unnecessary attendance at the emergency department (for example, easy availability of urgent primary care, protocols for ambulance services to discharge patients to a variety of destinations, access to urgent specialist clinics). Some, however, have suggested that it is better to adapt the emergency department system and that creating new routes may increase total workload.3

    In the emergency department patient flows must be optimised to avoid delay (for example, by streaming of patients). Adequate staff of appropriate seniority and training must be available, staff must be used to maximum benefit (for example, by matching staffing levels and workload by the hour, autonomous practice by nurse practitioners), and diagnostics …

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