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RCEM: study shows overcrowding in EDs is directly linked to patient harm

10 December 2019

Responding to today’s story in The Guardian about a study showing longer waits in Emergency Departments may increase the risk of death, President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “The reported findings are alarming but echo what the College has warned for some time: Emergency Department crowding kills.

“Without having seen this unpublished paper, it is difficult to draw definite conclusions, but these findings would be in line with the overwhelming body of evidence that demonstrates that overcrowding in Emergency Departments is directly associated with harm for both patients and staff.

“The harm for patients includes delays to getting the right care, simply not getting timely treatment, lack of privacy and dignity and increased complication rates for their illness.

“It has been clear for a long time that this results in higher rates of death in patients who are admitted from overcrowded departments.

“The scale of the effect has previously been described as being of the order of at least a 10% increase in mortality.

“The cause of the increase is not known but is likely to be a result of cumulative delays in care and errors in care due to overcrowding or from lack of staffing, both in EDs or in the system as a whole. We await the final peer reviewed publication of this paper with interest.

“What is clear is that corridor care cannot be allowed to continue. Metrics which measure flow and crowding are essential to ensure patient safety and RCEM is working with NHS England to make this happen. However, any new targets must be owned by the whole hospital and not just seen as an ED problem.

“Patients should be assured though that staff always seek to give the best care possible and always prioritise the very sickest patients.

“But the sheer numbers of patients waiting in EDs for over 12 hours is completely unacceptable and these findings, if proven, make clear that an increasing number of lives are at risk.

“Long waits are a signal, not the cause. They mean that the whole system is dangerously overloaded and therefore dangerous for patients.

“To ensure patients are moved through their treatment pathway as quickly as possible, we need adequate bed numbers and the right level of staffing in every single ED in the UK, and proper social care provision.

“The next government has a lot to do and must act quickly.”

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