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Emergency department overcrowding: a survey among European neurotrauma centres
  1. Kimberley Bernadette Velt1,
  2. Maryse Cnossen1,
  3. Pleunie P M Rood2,
  4. Ewout W Steyerberg1,
  5. Suzanne Polinder1,
  6. Hester F Lingsma1
  7. the CENTER-TBI investigators
  1. 1Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Emergency Medicine, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Maryse Cnossen, Department of public health, Erasmus MC, Rotterdam, CN 3015, The Netherlands; m.c.cnossen{at}


Background ED overcrowding is an increasing problem worldwide that may negatively affect quality of care and patient outcomes. We aimed to study ED overcrowding across European centres.

Methods Questionnaires on structure and process of care, including crowding, were distributed to 68 centres participating in a large European study on traumatic brain injury (Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury).

Results Of the 65 centres included in the analysis, 32 (49%) indicated that overcrowding was a frequent problem and 28 (43%) reported that patients were placed in hallways ‘multiple times a day’; 27 (41%) stated that multiple times a day, there was no bed available when a patient needed to be admitted. Ambulance diversion rarely occurred in the participating centres.

Conclusion Similar to reports from other parts of the world, ED crowding appears to be a considerable problem in Europe. More research is needed to determine effective ways to reduce overcrowding.

  • emergency department
  • quality
  • crowding

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  • Contributors KBV wrote the first draft of the manuscript and analysed the data. MC coordinated the development and examination of the provider profiling questionnaire, supervised the analyses and revised the paper. All authors critically commented on the manuscript and approved the final version.

  • Funding Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission 7th Framework Programme (602150).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval IRB of all centres participating in the CENTER-TBI study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data are not available.

  • Collaborators The CENTER-TBI investigators and participants are listed at