Emerg Med J. 2025 Dec 9:emermed-2025-215301. doi: 10.1136/emermed-2025-215301. Online ahead of print.

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.

PubMed:41365687 | DOI:10.1136/emermed-2025-215301