Emergency overcrowding: an incurable disease?

situation of the emergency department (ED) [1], highlighting common problems in diff erent countries that have remained unchanged and unresolved for decades [2]. Is there a solution to the collapse of emergency services or is it an incurable disease? Figure 1 shows the fl ows of input and output in an ED – modulating these fl ows can treat the problem. Th e clinician has no doubt that it is possible to reduce the infl ows under the argument that the ED should be handled with the diff erent purpose for which a priori or theoretically it has been designed – the reality is that the ED works like a quick family medicine service, and minor diseases are the predominant reason for consultation. Measures of popu lation healthcare education and restriction of attention in the ED exclusively for urgent patho logy are necessary. Yet there is an ethical justifi cation that carries weight – in a crowded service the safety of our patients is compromised, increasing the risk of delaying the early detection of time-dependent diseases. Regarding the emergency outfl ows, in our environment the main reason for overcrowding observation units is the presence of patients awaiting ward hospital beds. An obser vation unit is not a prehospitalization ward; in theory, these units were designed to accommodate patients while diagnostic uncertainties were being resolved and acute processes were being treated rapidly, thus avoiding unnecessary hospitalization [3]. Based on an exercise of responsibility, there is much work to do – starting with politicians, healthcare managers, health professionals and the public – to foment a rational use of ED services.