At any given time, nearly one in five patients in UK emergency departments are being treated in corridors, waiting rooms, or other non-standard overflow areas, according to a recent observational study published in the Emergency Medicine Journal. This approach, referred to as escalation area care, is now routinely used across almost all emergency departments in the country, despite contradicting national guidelines.
The study examined 165 out of 228 type 1 emergency departments—those with consultant-led, round-the-clock services and full resuscitation facilities—over five separate periods within ten days in March 2025. Data was collected using electronic health records, management systems, and real-time observations.
Researchers defined escalation areas as any space not regularly used unless standard capacity was exceeded. These included ambulance queues waiting over 15 minutes to offload patients, repurposed clinical spaces, hospital corridors or waiting rooms, and cubicles doubled up for multiple patients.
In total, 10,042 out of 56,881 observed patients (18%) were cared for in these overflow areas during the studied periods. Between 70% and 90% of sites reported using such spaces at each time point. Repurposed clinical spaces accounted for up to 39% of this care; non-clinical spaces like corridors and waiting rooms made up as much as 58%.
Children and individuals presenting with mental health issues were also found to be treated in these escalation areas across all surveyed times. In departments treating children, between 5% and 23% reported caring for them outside standard settings. For those with mental health needs, the proportion ranged from about one quarter to more than a third.
Regionally, Northern Ireland had the highest rates of escalation area use while the Southwest of England had the lowest. Adult-only emergency departments and smaller local hospitals saw greater reliance on these practices compared to major trauma centers.
Researchers noted that more patients were typically awaiting inpatient beds than being treated in escalation areas at any given time. They also found that between roughly one-tenth and one-quarter of sites had no immediate access to resuscitation cubicles—a situation they described as "a significant patient safety issue."
The authors concluded: "National guidance from NHS England states that escalation area use is not acceptable; this study demonstrates that it is widespread and routine. The same guidance states that children and those with mental health problems should never experience escalation area care; this study demonstrates that this is occurring regularly.
"Admitting patients awaiting an inpatient bed from the [emergency department] would largely solve the escalation area care problem… Healthcare policy makers must address this issue or openly accept escalation area care and its associated harms as a standard experience in UK emergency care."
A related editorial by leaders of the Royal College of Emergency Medicine suggested these findings may actually underestimate how often overcrowding forces patients into inappropriate treatment locations.
"The authors of this paper have successfully quantified the extent to which crowding leads to patients being treated in inappropriate spaces. If anything, their findings will be an underestimate," they stated.
They further noted: "Most recently, the harm associated with crowding has been quantified, such that for every 72 patients who wait 8–12 hours before admission there is one excess death."
The editorial argued that overcrowding stems not from excessive numbers arriving at emergency departments but rather delays moving admitted patients out—a problem known as exit block—and called for policy attention on improving patient flow through hospitals.
"Basically, if all the patients who required admission were taken out of the equation, the [emergency departments] in the study (remember that is most of the [emergency departments] in the UK) would not have been overcrowded. The issue is the exit block, and the policy focus needs to be on that," they insisted.
They acknowledged that while their research did not measure direct impacts on staff or patient experiences within escalation areas specifically: "Despite NHS England's guidance on 'providing safe and good quality care in temporary escalation spaces', it simply isn't possible to offer proper care in corridors and cupboards. Patients describe loss of autonomy, unmet expectations, and feelings of increased vulnerability. Many of these patients are elderly, frail, and vulnerable. Many have visual or hearing impairment or are confused. Many have extensive nursing needs."
They concluded: "The disconnect between guidance from politically driven organizations such as NHS England and the real world is starkly exposed here."
