Nearly 1 in 5 UK emergency department patients cared for in corridors/waiting rooms

(Press-News.org) At any one time, nearly 1 in 5 emergency department patients in the UK is being cared for in corridors, waiting rooms, and other non-standard ‘overflow’ spaces—an approach known as escalation area care—suggest the results of a large observational study, published online in Emergency Medicine Journal.

 

Almost all emergency departments in the UK are routinely deploying this approach, which contravenes national guidance, the findings indicate.

 

Amid the high prevalence of emergency department overcrowding in the UK, escalation area care is reported to be widespread, but there is no high quality evidence describing its prevalence, say the researchers.

 

This is especially important as escalation area care is known to compromise patient safety, generate substandard and undignified experiences for the patient, and is thought to be a factor in the heightened risk of death among patients enduring long waits in emergency departments, they add.

 

To gauge its true prevalence, the researchers studied clinical activity in 165 out of 228 type 1 emergency departments—those providing consultant-led, 24-hour services with full resuscitation facilities—at 5 different time points across 10 days in March 2025.

 

Local reporting teams relied on electronic health records, department management systems, and real-time observations to record the number of patients in escalation areas.

 

They also recorded the number of patients awaiting an inpatient bed; the number of cubicles or chair spaces in each emergency department (stratified by resuscitation room and non- resuscitation room status); whether there were children and patients with a presenting mental health issue in escalation areas; and the availability of resuscitation cubicles.

 

An escalation area was defined as ‘any area not routinely used unless the capacity of the usual emergency department geographical footprint is exceeded’ and they included: an ambulance queueing to offload for more than 15 minutes; a repurposed clinical area; a non-clinical area, such as a hospital corridor or waiting room; and a doubled-up cubicle.

 

The data showed that the treatment of emergency department patients in escalation area spaces was a regular and common occurrence.

 

The total number of patients in escalation areas across all 5 time points totalled 10,042, or 18% of all 56,881 patients in the participating emergency departments. And the proportion of sites reporting patients in escalation areas ranged from 70% to 90%.

 

A break-down of the total proportion of patients treated in the various types of escalation area in use showed that repurposed clinical spaces (31.5% to 39%) and non-clinical spaces, such as waiting rooms and corridors (53% to 58%), made up the lion’s share.

 

Overall, the time point with the highest number of patients in emergency departments (15, 933) was Monday at 7pm. The highest proportion of patients in escalation areas was Thursday at 7 am (the end of the clinical night shift), when more than 1 in 5 (21%) of all UK emergency department patients were being cared for in these locations, despite this being the period with the lowest total number of patients (7056).

 

Both children and patients with a mental health presentation were being cared for in these spaces across all 5 time points. Among the emergency departments seeing children, 5% to 23% reported treating them in escalation areas. And the proportion treating patients with a mental health presentation in these spaces ranged from 26% to 35.5%.

 

Regionally, the proportion of patients in escalation areas was consistently highest in Northern Ireland and lowest in the Southwest of England. And this proportion was highest in adult only emergency departments and smaller local emergency hospitals, and lowest in major trauma centres.

 

The number of patients waiting for an inpatient bed consistently exceeded the number of patients being cared for in escalation areas.

 

And the proportion of sites without any immediate resuscitation cubicle capacity ranged from 10.5% to 26%, “representing a significant patient safety issue,” note the researchers.

 

They conclude: “National guidance from NHS England states that escalation area use is not acceptable; this study demonstrates that it is widespread and routine. The same guidance states that children and those with mental health problems should never experience escalation area care; this study demonstrates that this is occurring regularly.

 

“Admitting patients awaiting an inpatient bed from the [emergency department] would largely solve the escalation area care problem… Healthcare policy makers must address this issue or openly accept escalation area care and its associated harms as a standard experience in UK emergency care.”

 

In a linked editorial, the immediate past and current presidents of the Royal College of Emergency Medicine, suggest that the findings are likely to be an underestimate.

 

“The authors of this paper have successfully quantified the extent to which crowding leads to patients being treated in inappropriate spaces. If anything, their findings will be an underestimate.”

 

They point out: “Most recently, the harm associated with crowding has been quantified, such that for every 72 patients who wait 8–12 hours before admission there is one excess death.”

 

The study provides further evidence on the cause of overcrowding in emergency departments, they highlight. It’s not the volume of patients coming in, but the flow out.

 

“Basically, if all the patients who required admission were taken out of the equation, the [emergency departments] in the study (remember that is most of the [emergency departments] in the UK) would not have been overcrowded. The issue is the exit block, and the policy focus needs to be on that,” they insist.

 

They add that the research didn’t measure the effects on patients and staff of escalation area spaces, but it stands to reason that this can’t be the best quality care.

 

“Despite NHS England’s guidance on ‘providing safe and good quality care in temporary escalation spaces’, it simply isn’t possible to offer proper care in corridors and cupboards. Patients describe loss of autonomy, unmet expectations, and feelings of increased vulnerability. Many of these patients are elderly, frail, and vulnerable. Many have visual or hearing impairment, or are confused. Many have extensive nursing needs,” they write.

 

“The disconnect between guidance from politically driven organisations, such as NHS England, and the real world is starkly exposed here,” they add.

END