IAEM Publications 2015
Irish Association for Emergency Medicine submission to the ED Taskforce
Irish Association for Emergency Medicine
Emergency Department (ED) crowding is caused by admitted patients spending long periods in the ED waiting for a hospital bed. Despite there being a nationally articulated recognition that this is due to system wide deficiencies, the problem is still referred to as ‘ED crowding’. A more appropriate description might be ‘Hospital crowding’. There are a number of well recognised adverse effects of ED/hospital crowding:
- Patients admitted through EDs at times when the ED is crowded have worse health outcomes for that admission, including a greater risk of death during their admission.
- Crowded EDs struggle to manage their workload and patient throughput becomes inefficient.
- Crowded EDs are unpleasant places to work and the impact on staff morale and wellbeing is such that ED medical and nursing recruitment and retention is an increasing challenge.
The immediate cause of ED crowding is a mismatch between supply of and demand for hospital beds to cater for the numbers of patients needing admission at that point in time. The need for admission is a result of inability to meet their immediate needs by any other means in the system process and practice on that day, not what might be available in the future. ED crowding is more the result of the flow of too many patients being delayed by many multiples of the time necessary to asses and treat them than the result of too many patients arriving in the first place.