Global Campaign Against ED Over-Crowding
IFEM's Position Statement on Over-Crowded Emergency Departments
The International Federation for Emergency Medicine (IFEM) is a federation of almost all the world’s national and regional specialist Emergency Medicine (EM) professional organizations. It connects networks of doctors and teams who practice EM.
IFEM’s vision is to create a world where all people, in all countries, have access to high quality emergency medical care.
A hospital’s Emergency Department (ED) is the area dedicated to receiving patients suffering sudden illness or injury. Medical and nursing staff with specialist EM training diagnose and treat patients 24 hours per day, working to treat and discharge patients home and to resuscitate and stabilize very sick patients who need hospital admission.
ED “over-crowding” occurs when there is an imbalance in patient demand, capacity of the ED to work efficiently and / or bed capacity within the hospital for those patients who need hospital admission. ED over-crowding is present in health systems across the globe and the situation has deteriorated significantly in the wake of the Covid-19 pandemic, which made the situation worse than ever before. Of 41 IFEM member countries surveyed in November 2022, 100% reported over-crowding in their ED’s.
The current state of over-crowding experienced at hospital Emergency Departments in many nations globally is an unacceptable and preventable threat to patient safety which must be immediately addressed.
What are typical causes?
- High numbers of patients coming to the ED (often the right alternative options do not exist or they fail to meet the demand for urgent, non-emergency healthcare)
- Insufficient supplies, staff or efficient process within the ED
- Too few hospital beds ready to receive ED patients so ED becomes gridlocked because patients are blocked from leaving the ED
Delays in transferring patients out of the ED is the most common problem. Sometimes all three factors are causing the problem.
What are the dangers?
Research shows that when ED’s are over-crowded, chaotic and stressful patient harm and even death occurs, through delays and mistakes resulting from an impossible workload. It means that patients have no privacy or dignity. Patients or their families can become aggressive towards staff. Staff morale becomes poor, and when the situation is there day after day, burnout happens. If staff leave, the situation deteriorates further.
In many countries ambulances are unable to offload patients and are kept waiting outside the ED. This stops them being able to respond to the next emergency case in the community.
What can be done to prevent patients being harmed?
Over-crowding is preventable. Transparency is needed and data will show the causes in that region. National and local policies must be created to protect Emergency Departments and their patients from the harms of the current state.
Political will is essential to disallow the view that over-crowding is “normal” or acceptable every day. It is not acceptable in other areas within the hospital. Conditions must allow the ED to be in a position to provide timely assessment and treatment to very sick patients at all times. We need to “press the reset button”.
Governments, healthcare system leaders and hospital administrators must work in partnership with local expert hospital emergency medicine leaders, to resolve this unsafe and untenable situation. Prompt and effective actions must be implemented across their health system.
We must be able to provide safe care for emergency patients.
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