Mitigating emergency department crowding: the role of advanced clinical practitioners

Emergency department (ED) crowding is a critical and persistent challenge in healthcare systems globally, with particularly acute effects in the UK. It is associated with increased patient morbidity and mortality, delays in care delivery, and significant staff burnout. The multifactorial nature of crowding - spanning input, throughput and output factors - necessitates a comprehensive and system-wide response. This article explores evidence-based strategies to mitigate ED crowding, focusing on the pivotal role of advanced clinical practitioners (ACPs) in senior-first clinical assessment, diagnostic streamlining and admission avoidance pathways. The author synthesises the latest evidence, policy guidance and clinical practice to argue for the expanded deployment of ACPs as a strategic solution to ED crowding. The article also provides system-level recommendations to support sustainable implementation and optimise emergency care outcomes.