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High levels of bed occupancy intuitively seem to be bad for patient care. Apart from the direct consequences of full wards and rapid turnover, the knock-on effects for the emergency department (ED) are likely to include exit block and consequent crowding, with associated threats to patient safety. Observational evidence suggests that high bed occupancy and ED crowding are associated with increased hospital mortality,1 ,2 but these data may be subject to confounding by case mix, since bed occupancy, ED crowding and mortality will all increase at times when the hospital has to manage seriously ill patients. What we really need to know is whether intervention to reduce bed occupancy leads to reduced ED crowding and mortality. …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.