Higher ED Occupancy Linked to 28-Day Mortality in UK Cohort

Key Takeaways

• Emergency departments in Wales, Northern Ireland, and England were operating, on average, at 175% occupancy, well beyond their available treatment spaces.
• Higher emergency department occupancy was associated with higher 28-day mortality. The investigator described the association for patients admitted to hospital.
• Corridor care was also associated with increased mortality, at a level in line with the occupancy association.
• Investigators extrapolated that crowding could have contributed to 554 deaths per week across the UK during the study period, with a plausible range of 33 to 1,083. They described the range as large because the study was relatively small.

Emergency departments may treat more patients than their available treatment spaces can accommodate, with some receiving care in corridors. Ryan McHenry, of the University of Glasgow, and colleagues investigated whether occupancy and corridor care track with mortality after emergency department treatment.

McHenry and colleagues presented their prospective multicenter cohort study as Abstract OA068, “The association between emergency department occupancy and mortality: a multi-centre prospective cohort study,” at the European Emergency Medicine Congress. The study included 19,034 patients treated in 134 hospital emergency departments in Wales, Northern Ireland, and England across five time periods in 2025. Investigators compared occupancy on the day of treatment with death from any cause within 28 days. Occupancy was the number of patients under treatment relative to available spaces such as cubicles (for example, 60 patients in a department with 50 cubicles is 120% occupancy). Corridor care meant treatment in nonstandard clinical spaces. Average occupancy across the departments was 175%. For every 10% increase in occupancy, the risk of death from any cause within 28 days increased by 1%.

Corridor care was also associated with increased mortality, in line with the occupancy association, though the researchers noted that occupancy is much easier to measure and record.

McHenry and colleagues extrapolated their results across the UK and estimated that crowding could have contributed to 554 deaths per week during the study period, compared with a situation in which departments had one space for every patient. They estimated that anywhere from 33 to 1,083 excess deaths per week was plausible. This figure was modeled from the association, not counted directly. The study was funded by the Royal College of Emergency Medicine.

The findings were presented as a congress abstract. Whether the analysis adjusted for patient or hospital characteristics has not been reported, which limits interpretation of this observational association. The researchers said the findings could inform how hospital managers and policymakers prioritize emergency care, and called for further studies to confirm the results and produce a more precise estimate of harm. The study did not test any intervention.