What is happening?
Crowding, also known as ‘overcrowding’ results in patients being cared for in corridors. This is undignified and inhumane, but also bad for patients. Crowding also creates an unpleasant and error prone working environment for staff.
Why does this matter?
This is the situation where the number of patients occupying the emergency department is beyond the capacity for which the emergency department is designed and resourced to manage at any one time. This results in an inability to provide safe, timely and efficient care to those patients, and any subsequent patients who attend the department.
Crowding is consistently associated with less good quality care for patients and increased mortality. The patients who are most affected by crowding are the elderly and the vulnerable. Ambulances are unable to offload, meaning longer waits for subsequent patients. Patients admitted through crowded emergency departments are more likely to end up on the wrong sort of ward and have a longer hospital stay as a result.
Who should take action and what do they need to do?
- Increase the bed capacity in hospitals to maintain flow in Emergency Departments. We estimate that at least 4,000 extra staffed beds are needed in England alone this winter to achieve 85% bed occupancy.
- Immediately publish a Social Care White Paper, with the view of expanding social care provision to improve patient flow and address delays in transfers of care in Acute Hospitals. Additional funding must address the £2.3 billion shortfall in social care faced by councils, as advocated by the Local Government Association.
- Improve clinician involvement with NHS 111 and call handling services. Referral rates drop if there is ready access to an experienced clinician to provide advice
- Understand local patterns of demand and configure services to match demand
- Crowding is minimised in hospitals where Boards are engaged.
- Performance standards should be seen as a hospital wide priority.
- Internal Professional Standards should be negotiated and delivered.
- Ensure patients can be discharged promptly from inpatient wards.
EM Clinical Leads
- Ensure there is a robust escalation plans
- Ensure there are systems that ensure safety during times of crowding.