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The articles on the problems of Emergency Department (ED) overcrowding make interesting reading, as the problems outlined are familiar to us in the UK, and I am sure that we would all identify similar causes and both short and long term solutions.
The list of stopgap measures, in the article by Fatovich and Hirsch  is also familiar to us all. Ambulance diversion is difficult outside larg...
The list of stopgap measures, in the article by Fatovich and Hirsch  is also familiar to us all. Ambulance diversion is difficult outside large cities with multiple EDs. Chief Executives are under pressure to avoid it. Similar problems arise with regard to postponing elective surgery. Reopening inpatient beds will take time, and the same applies to increasing the size and staffing of our EDs.
Much work nationally has been put into improving discharge processes, with notable successes. However bed management itself remains a big issue that is not really discussed by Fatovich and Hirsch. In my experience the number of times that there are genuinely no empty beds are rare, the beds are usually "the wrong type of bed". It cannot be denied that placing patients on outlying wards belonging to other specialties, even in their recovery phase, carries some clinical risk, and adds to the time need to complete ward work; this has led to resistance amongst our colleagues. Overcrowding of EDs, however must be a greater clinical risk.
This is an area that has not been discussed publicly. I would suggest the time has now come that we should stimulate this as a national issue. Resolution of ED overcrowding, in both the short and long term is a Trust-wide, and NHS-wide problem. Most of the solutions are beyond our individual control, and can only be achieved by working with our colleagues for the corporate good of our patients. By working together to utilise scarce beds even more efficiently I believe we can reduce the overflow problem, without impacting on elective activity.
This is yet another stopgap, but one that has not been openly discussed. Is it time we started this debate?
(1) Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J 2003;20:406-409.