title: International perspectives on emergency department crowding.
abstract: The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes.
authors.affiliation: Center for Health Care Quality, George Washington University, Washington, DC, USA. jesse.pines@gwumc.edu
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hilton
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Weber
authors.forename: Annechien J
authors.initials: AJ
authors.lastname: Alkemade
authors.forename: Hasan
authors.initials: H
authors.lastname: Al Shabanah
authors.forename: Philip D
authors.initials: PD
authors.lastname: Anderson
authors.forename: Michael
authors.initials: M
authors.lastname: Bernhard
authors.forename: Alessio
authors.initials: A
authors.lastname: Bertini
authors.forename: André
authors.initials: A
authors.lastname: Gries
authors.forename: Santiago
authors.initials: S
authors.lastname: Ferrandiz
authors.forename: Vijaya Arun
authors.initials: VA
authors.lastname: Kumar
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Barbara
authors.initials: B
authors.lastname: Hogan
authors.forename: Bo
authors.initials: B
authors.lastname: Madsen
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mason
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ohlén
authors.forename: Timothy
authors.initials: T
authors.lastname: Rainer
authors.forename: Niels
authors.initials: N
authors.lastname: Rathlev
authors.forename: Eric
authors.initials: E
authors.lastname: Revue
authors.forename: Drew
authors.initials: D
authors.lastname: Richardson
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sattarian
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
mesh_terms: D001315:Australia; D002170:Canada; D003441:Crowding; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005060:Europe; D005260:Female; D014943:Global Health; D006723:Hong Kong; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D038622:Internationality; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012537:Scandinavian and Nordic Countries; D014481:United States