• nursing
• emergency department nurses
• overcrowding
• emergency department
• policy

The papers by Trzeciak¹ and Fatovich,² along with the commentary by Schull,³ highlight the international dimension to the problem of crowed emergency departments (ED). To deal with this problem the United Kingdom National Health Service has published ambitious plans that state that all patients should be seen, assessed, treated, and either admitted or discharged within four hours.⁴ As part of this initiative, department times in the EDs in England were assessed during the last week in March. The published results indicated that almost all EDs met the interim “target” of having at least 90% of patients being discharged or admitted within four hours of arrival.

The question that many are asking is what does this target mean from the patient’s perspective? Few would disagree with using department times as a surrogate measure of efficiency and progress. All patients seem to take high quality care for granted and waiting time …