Emergency Department (ED) crowding and access block represent potentially the greatest threats to the core mission of emergency care across the world. The problem is pervasive, massive in scale, and amounts to a public health emergency with potentially lethal consequences. At its core, crowding and access block overwhelm ED resources and prevent the delivery of timely and effective care for patients. These are patients in need of necessary and immediate attention for the whole range of medical, trauma and behavioral emergencies that can impact a person or community. COVID-19 represents a prime example of how ED crowding and access block can serve as dangerous accelerants for pandemic infections. The causes of ED crowding and access block are complex and multifactorial and can vary considerably not only between hospitals, jurisdictions, and countries, but also within the same setting during different periods of time. As a ‘wicked problem’ for health care systems internationally, experts and thought leaders around the world have invested a remarkable amount of resources to understand the problem and formulate solutions. This report is designed to leverage that vast international experience and serve as a comprehensive global resource for EDs facing the challenge of crowding and access block.
This project was born during a discussion over breakfast at the Emirates Society of Emergency Medicine conference in 2018. An ED chief in the Middle East lamented the tragic outcome of a young man in his forties, a father of four, who died due to a fat embolus from a femoral fracture as he waited in the ED for 48 hours for an in-hospital bed that was required for operative intervention. The challenges faced by that member of our global EM community exemplify why we need an urgent, coordinated, and multifaceted response.
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