Preventing ‘exit block’ in emergency departments
Intended for healthcare professionals
Art & Science Previous     Next

Preventing ‘exit block’ in emergency departments

Kevin Cairney Head of nursing, 24/7 patient safety team, Croydon Health Services NHS Trust, London
Elaine Clancy Deputy chief operating officer, Croydon Health Services NHS Trust, London

Kevin Cairney and Elaine Clancy explain how a site practitioner early warning system can alert urgent care staff to problems with capacity and patient flow

Overcrowding due to poor patient flow increases risk for more than 500,000 patients a year (College of Emergency Medicine (CEM) 2014) and is linked to increased mortality (Geelhoed and de Klerk 2012). CEM (2014) has called for urgent action to address ‘exit block’ in UK emergency departments (EDs). In October last year, Croydon Health Services NHS Trust designed and implemented a site practitioner early warning system (SPEWS) to alert staff to capacity and flow pressures in the ED, and to initiate escalation to a nurse-led, protocol-driven response. Under pressurised and time-critical conditions, SPEWS ensures rigour and conformity in exchanges between clinical emergency care staff and managers. The result is closer collaboration between clinicians and managers, optimised patient flow and mitigated risk from exit block.

Emergency Nurse. 22, 7, 20-26. doi: 10.7748/en.22.7.20.e1375



Peer review

This article has been subject to double blind peer review

Conflict of interest

None declared

Received: 01 October 2014

Accepted: 16 October 2014

Want to read more?

Already subscribed? Log in


Unlock full access to RCNi Plus today

Save over 50% on your first 3 months

Your subscription package includes:
  • Unlimited online access to all 10 RCNi Journals and their archives
  • Customisable dashboard featuring 200+ topics
  • RCNi Learning featuring 180+ RCN accredited learning modules
  • RCNi Portfolio to build evidence for revalidation
  • Personalised newsletters tailored to your interests
RCN student member? Try Nursing Standard Student

Alternatively, you can purchase access to this article for the next seven days. Buy now