International Perspectives on Emergency Department Crowding

Abstract

The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear

Overcrowding in emergency department: an international issue

“…Economic viability is a very important factor in the closure of EDs. This problem, however, does not just affect the American health care system, but is an International public health issue [4].…”

Two emergency departments, 6000 km apart: Differences in patient flow and staff perceptions about crowding

“…One of the most critical issues affecting emergency department (ED) delivery of care worldwide is 47 crowding [1]. ED crowding is defined as a state where care demands exceed available resources, 48 resulting in long waits for tests and treatments [2][3][4].…”

Positionspapier für eine Reform der medizinischen Notfallversorgung in deutschen Notaufnahmen

“…Das Patientenaufkommen in Notaufnahmen nimmt vor dem Hintergrund der demographischen Entwicklung, der zunehmenden Multimorbidität der Bevölkerung, der Reduktion alternativer, auch ambulanter Versorgungsstrukturen, der Veränderung der prähospitalen Notfallversorgung und der Etablierung von überregionalen Netzwerken auch in Deutschland kontinuierlich zu. Angegeben werden jährliche Steigerungen der Fallzahlen von 4-8 % [3,4,10].…”