It has been an interesting few days as the hospital I work in has been in the news for overcrowding. There sometimes feels like there’s a disconnect between overcrowding and patient safety. On one hand, the international evidence repeatedly shows that ED overcrowding has a negative effect on patient outcome, with increased morbidity and mortality. On the other hand, we are all working in busy EDs, and many patients are getting timely, appropriate care from hard-working staff in spite of these pressures. We are hanging on, doing our best, etc, etc.
The disconnect is because while overcrowding does increase patient risk, it doesn’t change the outcome for every patient. The best way to explain this is by the speed limit analogy.