RCEM Crowding guide for shift leaders - summary
One-line principle Crowding = demand
capacity. Exit block (output failure) is usually the dominant driver of ED crowding (RCEM 2024). Identifying whether input, throughput or output is dominant focuses practical mitigation and escalation.
Key responsibilities for the shift leader
- Lead, verify and document escalation through standard local channels.
- Ensure the duty/site manager and operational teams are aware and are implementing agreed actions.
- Continuously assess patient safety and the department’s capacity to accept critically ill arrivals.
- If the department cannot guarantee safe care for incoming life‑threatening patients, consider declaring an internal critical/major incident in line with local EPRR arrangements (GOV.UK) and record the clinical rationale.
Causes of crowding (concise)
Immediate safety priorities (non-negotiables)
- Prioritise a structured handover and walk the department immediately afterwards to identify patients at immediate risk.
- Ensure deteriorating patients are recognised and receiving rescue treatment (monitoring, oxygen, analgesia, sepsis care).
- Confirm availability and location of critical drugs, fluids, oxygen and cognitive aids; delegate follow‑up for outstanding investigations and abnormal results.
- Protect the capacity to accept and stabilise critically ill arrivals; if threatened, activate contingency plans and notify partner services.