How many patients attending London Emergency Departments could be managed elsewhere? A whole-system review of missed opportunities for care in more appropriate settings

ABSTRACT Emergency Departments (EDs) in England experience sustained crowding, affecting patient and staff experience, safety and system flow. This programme of work aimed to identify opportunities where patients attending London EDs could have been managed safely in alternative settings, and to explore what this reveals about system design, access and behaviour within the London Urgent and Emergency Care (UEC) system. A cross-sectional retrospective observational study reviewed over 2,000 patient attendances across 27 London Type 1 EDs between October 2021 and October 2023. A type 1 ED is defined as a consultant led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients 1 . Multidisciplinary panels assessed appropriateness and potential alternative pathways. Between 66% and 81% of patients were judged suitable for non-ED care, yet only 29% were redirected or streamed away. These findings largely reflected whole-system factors rather than the performance of individual organisations.