International perspectives on emergency department crowding

Area of Science:

• Global Health
• Emergency Medicine
• Health Systems Research

Background:

• Emergency medicine (EM) has matured as a specialty alongside rising emergency department (ED) visit rates worldwide.
• ED crowding, a mismatch of resources and demand, leads to delays and negative clinical outcomes, including increased mortality.
• This issue is a significant public health concern globally.

Purpose of the Study:

• To describe emergency care systems and the extent of crowding in 15 countries outside the United States.
• To identify common causes and mitigation strategies for ED crowding.
• To provide insights for addressing ED crowding in the United States.

Main Methods:

• Comparative analysis of emergency care systems and crowding in 15 countries.
• Inclusion of data on visit patterns where available.
• Incorporation of subjective assessments from local emergency care leaders.

Main Results:

• Most included countries show increasing ED visit rates and crowding, even with universal health coverage.
• Patient boarding is a primary cause of crowding, similar to the US.
• Scandinavian countries with strong non-ED acute care systems report less crowding.
• Various operational interventions are being implemented, with mixed success.

Conclusions:

• ED crowding is a worsening global problem, driven largely by patient boarding.
• Effective strategies may involve operational interventions and health policy changes.
• Lessons from international systems can inform US-based solutions for ED crowding.