Should Emergency Departments Exist?

It sounds like a daft question. Of course they should.

But the way emergency departments currently operate is not what they were designed for. Millions of patients wait hours — sometimes many hours — before any form of assessment or intervention. We experience them ourselves and hear about them from friends and relatives and now accept them as the cost of a health system under extreme pressure. In fact long waits have become so routine that they are no longer shocking.  The target of 95% of patients being managed within 12 hours also hasn’t been achieved in the last 10 years.

We should not accept this. And the evidence is now catching up with what clinicians have known for years.

Overcrowding is killing people

A major study presented on 25 September 2026 at the European Emergency Medicine Congress found that every 10% increase in ED occupancy was associated with a 1% rise in the likelihood of a patient dying within 28 days. At the occupancy levels now considered normal in English emergency departments, that is not a marginal risk. It is a systemic one.

Dr Ian Higginson, President of the Royal College of Emergency Medicine, put it plainly: "People are dying in association with overcrowding in Emergency Departments. This should be cause for alarm among policymakers, and yet we are not seeing any urgency."

The problem is not the clinical teams working in emergency departments. It is the model itself, a single front door into hospital through which every urgent and emergency presentation must pass, regardless of whether that is the right setting for the patient in front of you.

There is a better way

For years, Cinapsis has supported an alternative admission model. Rather than defaulting every patient to an emergency department, GPs and paramedics can reach a specialist or Single Point of Access team directly, get a clinical decision in real time, and have patients admitted directly to the right unit — an SDEC, a ward, an acute medical unit — without going through ED at all.

The difference this makes is no longer just anecdotal. Data from Gloucestershire Hospitals NHS Foundation Trust shows that patients admitted directly to clinical units through the Cinapsis pathway have better mortality outcomes than those admitted via the emergency department. The trust's own analysis, adjusted for age, sex, diagnosis and co-morbidities, found a clear mortality benefit for patients who bypass ED, equivalent to one life saved per day.

In 2025/26, 93.5% of acute medicine cases handled through the Gloucestershire pathway reached their destination without an ED attendance. The median time to reach a specialist was 25 seconds.

What this means for urgent care

Emergency departments are not going away. There will always be patients who need help in an emergency and for whom ED is the right place to attend. The question is not whether EDs should exist. It is whether they should be the default front door for every patient who needs urgent care.

The evidence says no. Multiple front doors, with patients routed to the right setting at the point of referral rather than triaged on arrival at a single point of congestion, produces better outcomes. Earlier, decisive specialist intervention. Fewer unnecessary ED attendances. Shorter waits for the patients who genuinely need emergency care. Lower costs for the local health economy.

The clinical case is made. The financial case is made. What is missing, as Dr Higginson suggests, is the urgency from policymakers to commit to a different model and the confidence from local healthcare leaders to establish these new pathways..

To find out how Cinapsis supports direct admission pathways and urgent care redesign, get in touch with our team. You can also read why urgent care referrals fail when the pathway isn't designed for them.