EDs across Scotland have experienced significant difficulties in achieving the emergency access standard in recent years. There are many reasons for this, including input, throughput and output issues in relation to patient flow. Poor patient
flow results in crowding in EDs and assessment areas, and has negative implications for patient experience, quality and safety.
The symptoms of poor patient flow are evident in EDs. EDs can, for example, become crowded when patients cannot be transferred to admission wards because of capacity issues. This contributes to ED crowding, with new patients not being assessed and existing patients neither being managed in an ideal environment nor receiving specialist input. Those with an acute need for specialist input are often elderly and are among the most vulnerable members of the ED population.
The causes of poor patient flow – and therefore the solutions – are system-wide and require a whole-system approach if they are to be addressed.
This guidance, produced by the Unscheduled Care steering group and endorsed by the Cabinet Secretary for Health, Wellbeing and Sport, proposes the development of a standard operating procedure to avoid crowding by proactively managing capacity in the ED within the context of the 6 Essential Actions to Improving Unscheduled Care. The guidance also includes escalation steps that can be taken when crowding occurs.