• emergency care systems
• emergency care systems, efficiency
• emergency department management
• guidelines

The ambulances can't offload, the minor's patients are agitating for attention, the nurses are frazzled, the managers are worried and the resuscitation room has the same patients waiting hours and hours for an intensive care unit bed.

Crowding in emergency departments is one of the leading problems facing our patients and our specialty. The multiple adverse harms of being a patient in a crowded emergency department are increasingly understood and reported. Almost every aspect of patient care, staff well-being, training and retention is worse in a crowded emergency department. Crowding creates dreadful working conditions and almost certainly contributes to the recruitment difficulties in British emergency medicine. Most seriously, attending a crowded emergency department increases the risk of death.

Crowding is usually a consequence of exit block, where there is insufficient capacity, or inadequate coordination of capacity, within a hospital. Recent, well-publicised national failings against the 4 h …