The authors have no relevant financial information or potential conflicts of interest to disclose.
Original Research Contributions
International Perspectives on Emergency Department Crowding
Article first published online: 13 DEC 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: Proceedings of the 2011 AEM Consenus Conference: Interventions to Assure Quality in the Crowded Emergency Department Guest Editors: James R. Miner, MD Manish N. Shah, MD, MPH
Volume 18, Issue 12, pages 1358–1370, December 2011
How to Cite
Pines, J. M., Hilton, J. A., Weber, E. J., Alkemade, A. J., Al Shabanah, H., Anderson, P. D., Bernhard, M., Bertini, A., Gries, A., Ferrandiz, S., Kumar, V. A., Harjola, V.-P., Hogan, B., Madsen, B., Mason, S., Öhlén, G., Rainer, T., Rathlev, N., Revue, E., Richardson, D., Sattarian, M. and Schull, M. J. (2011), International Perspectives on Emergency Department Crowding. Academic Emergency Medicine, 18: 1358–1370. doi: 10.1111/j.1553-2712.2011.01235.x
Supervising Editor: Manish Shah, MD.
- Issue published online: 13 DEC 2011
- Article first published online: 13 DEC 2011
- Received February 17, 2011; revisions received May 9 and May 18, 2011; accepted May 18, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1358–1370 © 2011 by the Society for Academic Emergency Medicine
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 plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes.