Views And Reviews

This emergency department crisis was predictable—and partly preventable

BMJ 2018; 360 doi: (Published 08 January 2018) Cite this as: BMJ 2018;360:k64
  1. Adrian Boyle, consultant emergency physician and chair of the quality emergency care committee,
  2. Ian Higginson, consultant emergency physician and registrar
  1. Royal College of Emergency Medicine, UK
  1. adrian.boyle{at}

The solutions are not complicated, but they require recognition that there is a problem

Emergency departments in the UK have been under unprecedented pressure over the past few months. The uninformed observer could be forgiven for thinking that this is a winter phenomenon—the reality is that this pressure has been steadily building for years. A toxic combination of increasing demand, full hospitals, and inadequate social care capacity has created a perfect storm centred on under-resourced emergency departments. Influenza and norovirus increase the difficulties.

Ambulances waiting outside emergency departments are unable to attend urgent calls. Inside, trolley patients are assessed in corridors by exhausted staff who struggle to get a history and can only perform a limited examination in open areas. There is …

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