2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T82f,Emergency department (ED) utilisation and delays are a major public health concern internationally, with increased mortality with ED delays and overcrowding. The study aimed to assess how the population characteristics of ED catchment areas are associated with ED use and delays to admission or discharge, and how catchment presentation rates are associated with ED delays. A cross-sectional study of presentations and delays to all 27 Scottish EDs for December 2023-February 2024. Catchment areas were defined for every ED in Scotland and population demographics for each, as Scottish Index of Multiple Deprivation (SIMD) and 8-fold Urban-Rural Classification (UR8). ED performance metrics for the study period were extracted from routinely reported data. Robust regression assessed the associations between catchment area demographics and ED delays, with negative binomial regression analysis of the association between catchment area demographics and presentation rates for the local population, reported as incidence rate ratio (IRR). For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge. EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity.31:Ta7b, Background Emergency department (ED) utilisation and delays are a major public health concern internationally, with increased mortality with ED delays and overcrowding. The study aimed to assess how the population characteristics of ED catchment areas are associated with ED use and delays to admission or discharge, and how catchment presentation rates are associated with ED delays. Methods A cross-sectional study of presentations and delays to all 27 Scottish EDs for December 2023–February 2024. Catchment areas were defined for every ED in Scotland and population demographics for each, as Scottish Index of Multiple Deprivation (SIMD) and 8-fold Urban–Rural Classification (UR8). ED performance metrics for the study period were extracted from routinely reported data. Robust regression assessed the associations between catchment area demographics and ED delays, with negative binomial regression analysis of the association between catchment area demographics and presentation rates for the local population, reported as incidence rate ratio (IRR). Results For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge. Conclusion EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity. 32:T7a7,Emergency department (ED) crowding is an international concern. It results in care being delivered in non-standard treatment spaces including corridors, termed escalation areas in the UK. Limited data suggest their use is widespread. This study aimed to establish the prevalence of UK escalation area use at a national level. A prospective cross-sectional point prevalence study was carried out in 165 UK EDs over five snapshots in March 2025 selected to represent a range of expected ED activity. The primary outcome was the proportion of patients receiving care in escalation areas. Secondary outcomes were the number of patients awaiting an inpatient bed, ED occupancy and resuscitation capacity. The presence of paediatric patients and those with mental health presentations in escalation areas is also reported. Across the five snapshots, 17.7% (n=10 042) of ED patients were receiving care in escalation areas. At each snapshot there were more patients awaiting an inpatient bed than patients in escalation areas. The percentage of escalation area patients in non-clinical areas such as corridors ranged from 54.5% to 61.1%. ED occupancy (patients per cubicle space) ranged from 1.0 (IQR 0.7-1.4) to 2.4 (IQR 1.8-3.1). There was no available resuscitation cubicle at 10.5% (n=17/162) to 26.2% (n=43/164) of sites. Paediatric and mental health patients were receiving care in escalation areas across all time points. Almost one in five ED patients was experiencing escalation area care during the five snapshots. National guidance states escalation area use is not acceptable; this research demonstrates it is routine. This study supports the hypothesis that, to address ED escalation area care, the focus should be on facilitating the flow of patients who require an inpatient bed out of the ED. Further research should consider the effect of escalation area care on patient level outcomes and the effectiveness of interventions to reduce ED crowding.33:T9f5, Introduction Emergency department (ED) crowding is an international concern. It results in care being delivered in non-standard treatment spaces including corridors, termed escalation areas in the UK. Limited data suggest their use is widespread. This study aimed to establish the prevalence of UK escalation area use at a national level. Methods A prospective cross-sectional point prevalence study was carried out in 165 UK EDs over five snapshots in March 2025 selected to represent a range of expected ED activity. The primary outcome was the proportion of patients receiving care in escalation areas. Secondary outcomes were the number of patients awaiting an inpatient bed, ED occupancy and resuscitation capacity. The presence of paediatric patients and those with mental health presentations in escalation areas is also reported. Results Across the five snapshots, 17.7% (n=10 042) of ED patients were receiving care in escalation areas. At each snapshot there were more patients awaiting an inpatient bed than patients in escalation areas. The percentage of escalation area patients in non-clinical areas such as corridors ranged from 54.5% to 61.1%. ED occupancy (patients per cubicle space) ranged from 1.0 (IQR 0.7–1.4) to 2.4 (IQR 1.8–3.1). There was no available resuscitation cubicle at 10.5% (n=17/162) to 26.2% (n=43/164) of sites. Paediatric and mental health patients were receiving care in escalation areas across all time points. Conclusion Almost one in five ED patients was experiencing escalation area care during the five snapshots. National guidance states escalation area use is not acceptable; this research demonstrates it is routine. This study supports the hypothesis that, to address ED escalation area care, the focus should be on facilitating the flow of patients who require an inpatient bed out of the ED. Further research should consider the effect of escalation area care on patient level outcomes and the effectiveness of interventions to reduce ED crowding. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Emergency Department Crowding: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Emergency Department Crowding (condition). Clinician-written summaries and actionable practice insights. 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Compared to a 2-hour ED stay, adjusted odds of 30-day death rose progressively: aOR 1.1 (95% CI 1.07–1.14) at 3 hours, 1.6 (1.48–1.68) at 6 hours, 1.9 (1.80–2.03) at 9 hours, and 2.1 (2.02–2.28) at 12 hours.","limitations":"- Cross-sectional, observational design cannot establish causality; residual confounding is a major concern.\n- Study restricted to non-immediate acuity patients in England's Type 1 EDs, limiting generalizability to other settings or higher-acuity presentations.\n- Reasons for longer stays (e.g., clinical complexity vs. system crowding) were not disentangled, making it unclear whether ED time itself drives mortality.","practice_takeaway":"Prolonged ED stays are linked to meaningfully higher 30-day mortality risk, even in non-immediate patients — but causality is unproven. Clinicians and administrators should treat ED length-of-stay as a potential patient safety signal worth monitoring, while awaiting causal research."}},{"doi":"10.1016/j.annemergmed.2026.06.013","pmid":"42405915","title":"Do Hospitals Turn Away Ambulances Only When Busy, or When Their Peers Do?","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-07-06T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.06.013","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-12T13:19:39.647Z","updated_at":"2026-07-12T13:19:39.647Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"condition","value":"Ambulance Diversion","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"condition","value":"Emergency Department Crowding","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"study_design","value":"Observational Study","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"warning","value":"Level of evidence and sample size tags were omitted due to insufficient information in the provided source.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or conclusions were available. All summary fields requiring specific findings, sample size, population details, or outcomes have been left null or set to the most conservative values possible.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.06.013","tag_type":"warning","value":"Study design tag is tentative; the actual methodology (e.g., retrospective cohort, cross-sectional, econometric) cannot be confirmed without access to the full text.","value_numeric":null}],"summaries":{"what_studied":"This study examined whether hospital decisions to go on ambulance diversion are driven solely by internal capacity (being busy) or also influenced by peer hospitals diverting simultaneously — evaluating the role of social/strategic contagion in diversion behavior.","limitations":"The paper text provided contains only the title and metadata, with no abstract, methods, results, or conclusions available for extraction — no specific findings or numbers can be reported."}},{"doi":"10.1111/acem.70330","pmid":"42149586","title":"When Metrics Replace Values: Ethical Concerns in Healthcare Performance Measures","journal_title":"Academic Emergency Medicine","journal_issn":"1069-6563","published_at":"2026-05-18T00:00:00.000Z","url":"https://doi.org/10.1111/acem.70330","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-26T13:35:09.356Z","updated_at":"2026-05-26T13:35:09.356Z","tags":[{"paper_doi":"10.1111/acem.70330","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"condition","value":"Emergency Department Crowding","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"condition","value":"Healthcare Quality Measurement","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"study_design","value":"Commentary","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"warning","value":"Generalizability beyond U.S. emergency department settings is not addressed.","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"warning","value":"No original empirical data presented; this is an opinion/commentary piece—evidence level reflects expert opinion only.","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"warning","value":"Sex of study population is not applicable given the commentary design; sex tag omitted.","value_numeric":null},{"paper_doi":"10.1111/acem.70330","tag_type":"warning","value":"The paper does not report a sample size; the sample_size tag has been omitted.","value_numeric":null}],"summaries":{"what_studied":"This commentary examines the ethical problems that arise when healthcare performance metrics—specifically the Emergency Department 'Left Without Being Seen' (LWBS) rate—shift from measurement tools to performance targets, analyzing implications for distributive justice, beneficence, and professional integrity.","key_result":"LWBS-reduction strategies (e.g., provider-in-triage, rapid low-acuity evaluation) demonstrably lower the measured metric but do not consistently improve patient outcomes; they may misallocate scarce ED resources toward lower-acuity patients, leave vulnerable patients with unmet needs, and generate clinician moral distress.","limitations":"- Commentary with no original dataset; conclusions rely on synthesis of cited literature rather than new empirical evidence.\n- Analysis focuses on a single metric (LWBS), limiting generalizability to other quality measures.\n- No formal systematic review or meta-analytic methodology; author's institutional perspective may influence framing.","practice_takeaway":"Clinicians and administrators should treat quality metrics as provisional tools with defined lifecycles—building in periodic reassessment and the option to retire measures when unintended consequences emerge. Resist workflow changes that optimize a metric at the expense of high-acuity care or fiduciary duties to individual patients."}},{"doi":"10.1111/1742-6723.70265","pmid":"42141516","title":"“Stuck” on the Ramp: What Factors Influence Patient Comfort and Satisfaction While Waiting on Emergency Department Ramps? A Qualitative Analysis","journal_title":"Emergency Medicine Australasia","journal_issn":"1742-6731","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1111/1742-6723.70265","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-18T13:25:33.944Z","updated_at":"2026-05-18T13:25:33.944Z","tags":[{"paper_doi":"10.1111/1742-6723.70265","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"condition","value":"Ambulance Ramping","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"condition","value":"Emergency Department Crowding","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"sample_size","value":"n=26","value_numeric":26},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"study_design","value":"Qualitative Study","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"warning","value":"Qualitative thematic analysis is inductive and reflects participant perceptions only — no clinical outcome data or intervention efficacy is reported.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"warning","value":"Sample size is small (n=26); saturation of themes is not explicitly discussed in the abstract.","value_numeric":null},{"paper_doi":"10.1111/1742-6723.70265","tag_type":"warning","value":"Study is conducted in Australia; ramping practices and ED infrastructure may differ significantly in other health systems, limiting direct applicability elsewhere.","value_numeric":null}],"summaries":{"what_studied":"Semi-structured interviews with 26 patients who waited ≥1 hour on ambulance ramps at two Australian emergency departments, exploring the patient experience and what built environment or care changes could improve comfort and satisfaction during ramping.","key_result":"Four major themes emerged: psychological distress, physical discomfort, unsuitable built environment, and challenges to maintaining physical health. Participants identified specific modifications to the built environment and care practices that could better support patient-centred care while ramped.","limitations":"Small sample (n=26) from only two Australian EDs limits generalisability. Qualitative design does not allow quantification of harm or frequency of concerns. Study does not evaluate the effect of any proposed interventions.","practice_takeaway":"While structural changes to ramp environments are difficult in the short term, ED teams can act now on care-delivery aspects — such as communication, pain management, and basic comfort measures — to reduce distress for ramped patients."}},{"doi":"10.1136/emermed-2024-214837","pmid":"41475794","title":"Association between catchment-area demographics and emergency department presentation rates and delays: a national cross-sectional study","journal_title":"Emergency Medicine Journal","journal_issn":"1472-0205","published_at":"2026-01-01T00:00:00.000Z","url":"https://doi.org/10.1136/emermed-2024-214837","source_score":9,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-04","doi":"10.1136/emermed-2024-214837","days":"30","issn":"1472-0205","rank":"6","field":"Clinical Medicine","score":"9","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1136/emermed-2024-214837","title":"Association between catchment-area demographics and emergency department presentation rates and delays: a national cross-sectional study.","journal":"Emergency medicine journal : EMJ","methods":"","results":"For each decile lower (more deprived) in median SIMD, monthly attendances increased by 10% (IRR 1.10, 95% CI 1.10 to 1.11). For each step more rural in the median UR8 of a catchment, the percentage of patients experiencing a delay to admission or discharge of over 4 hours reduced by 5.3% (95% CI 4.9% to 5.7%), and each step more deprived in median SIMD decile of a catchment area was associated with 4.8% more delays beyond 4 hours (95% CI 3.0 to 6.8%). There was no association between presentation rates and delay to admission or discharge.","abstract":"$30","keywords":["Healthcare Disparities","crowding","emergency care systems"],"pubmed_id":"41475794","conclusions":"EDs with more deprived catchment areas have higher presentation rates and greater delays in care. More rural EDs have fewer delays, which may mitigate some of the effects of geographical isolation in the provision of more timely care. In isolation, ED presentation rates are not associated with delays to care, adding to evidence that overall attendances are less important than other factors contributing to ED delays. Policymakers should consider the allocation of resources to best promote health equity.","publication_date":"2026-01-01T00:00:00"},"crossref":{"DOI":"10.1136/emermed-2024-214837","URL":"https://doi.org/10.1136/emermed-2024-214837","ISSN":["1472-0205","1472-0213"],"link":[{"URL":"https://syndication.highwire.org/content/doi/10.1136/emermed-2024-214837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"emermed-2024-214837","type":"journal-article","issue":null,"score":1,"title":["Association between catchment-area demographics and emergency department presentation rates and delays: a national cross-sectional study"],"author":[{"given":"Ryan","family":"McHenry","sequence":"first","affiliation":[{"name":"ScotSTAR, Paisley, UK"}]},{"given":"Christopher E J","family":"Moultrie","sequence":"additional","affiliation":[{"name":"ScotSTAR, Paisley, UK"}]},{"given":"Alasdair R","family":"Corfield","sequence":"additional","affiliation":[{"name":"Emergency Department, Royal Alexandra Hospital, Paisley, UK"}]},{"given":"Daniel F","family":"MacKay","sequence":"additional","affiliation":[{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}]},{"given":"Jill P","family":"Pell","sequence":"additional","affiliation":[{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}]}],"funder":[{"name":"Scottish Ambulance Service"}],"issued":{"date-parts":[[2025,12,30]]},"member":"239","prefix":"10.1136","source":"Crossref","volume":null,"created":{"date-time":"2025-12-31T06:00:22Z","timestamp":1767160822000,"date-parts":[[2025,12,31]]},"indexed":{"date-time":"2025-12-31T06:02:12Z","timestamp":1767160932550,"date-parts":[[2025,12,31]]},"subject":[],"abstract":"$31","accepted":{"date-parts":[[2025,12,17]]},"language":"en","relation":{},"resource":{"primary":{"URL":"https://emj.bmj.com/lookup/doi/10.1136/emermed-2024-214837"}},"subtitle":[],"deposited":{"date-time":"2025-12-31T06:00:25Z","timestamp":1767160825000,"date-parts":[[2025,12,31]]},"issn-type":[{"type":"print","value":"1472-0205"},{"type":"electronic","value":"1472-0213"}],"published":{"date-parts":[[2025,12,30]]},"publisher":"BMJ","reference":[{"DOI":"10.52964/AMJA.0919","key":"2025123022001359000_emermed-2024-214837v1.1","year":"2022","issue":null,"author":"Cooksley","volume":"21","first-page":"166","unstructured":null,"article-title":"Editorial - 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Each step more rural was associated with 5.3% fewer >4-hour delays (95% CI 4.9–5.7), while each step more deprived was associated with 4.8% more >4-hour delays (95% CI 3.0–6.8). There was no association between presentation rates and delay.","practice_takeaway":"EDs serving more deprived communities see more attendances and more delays, while more rural catchments have fewer delays. Do not assume lowering attendances alone will reduce delays; target system factors and equity-focused resource allocation."}},{"doi":"10.1136/emermed-2025-215301","pmid":"41365687","title":"Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study","journal_title":"Emergency Medicine Journal","journal_issn":"1472-0205","published_at":"2025-12-10T00:00:00.000Z","url":"https://doi.org/10.1136/emermed-2025-215301","source_score":211,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-12","doi":"10.1136/emermed-2025-215301","days":"30","issn":"1472-0205","rank":"1","field":"Clinical Medicine","score":"211","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1136/emermed-2025-215301","title":"Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study.","journal":"Emergency medicine journal : EMJ","methods":"","results":"Across the five snapshots, 17.7% (n=10 042) of ED patients were receiving care in escalation areas. 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