Patient experience. Quick decisions mean a quick exit.

Patients admitted to A&E in the evening can stay in hospital up to four days longer than morning admissions. Trusts can take targeted action during the assessment phase to reduce patient stays, explain Seamus McGirr and colleagues

Improved patient pathways can prevent overcrowding.

Emergency department (ED) crowding is a common problem throughout the western world. Not only does crowding create a miserable environment for patients, and to considerable stress and poor job satisfaction among staff, it can also lead EDs to breach the four-hour standard and other care quality indicators. In addition, crowding in EDs correlates with increases in patient mortality, rates of admission, lengths of inpatient stay and costs. This article argues that crowding is best tackled by the consistent application of eight principles, derived from various guidance, to emergency patient pathways, particularly those in acute settings.