To the Editor: The editorial by Cameron and Campbell on access block is an excellent summary of the causes and potential solutions to access block.1 The effects of overcrowding in the emergency department (ED) have been previously reported, including risks to patient safety, prolonged pain and suffering, and decreased clinical productivity and effectiveness.2 Access to emergency care is impaired.

The fundamental problem is that while demand has increased, the capacity of the system has decreased.3 This is best exemplified by the significant reduction in hospital bed numbers.

Healthcare in Western societies has been through a period of severe economic rationalisation, resulting in closure of thousands of beds in the acute hospital system. For example, in the United States, the number of medical and surgical beds declined by 18% in the period 1994–1999. From 1990 to 1999, attendances at EDs increased 15%. There have also been many aged care beds closed or changed to community-based facilities.4 It has been suggested that the problem is "a badly flawed approach to financing health care that values profits over patients."5

Spare bed capacity is essential for the effective management of emergency admissions. At least one study has found that if hospital bed occupancy rates exceed 85%, then bed crises occur.6 In fact, the Guinness Book of World Records now has a category for longest wait on a hospital trolley!7 The official record currently stands at 77 hours 30 minutes, although anecdotes report longer times. It is paradoxical that other departments within a hospital cannot exceed 100% occupancy, and yet the ED, which may contain some of the most seriously ill or injured, is allowed to exceed the safe level of 100% occupancy.

The ED has always been available to help if all else fails in the healthcare system. That basic tenet is now being challenged, and the general public may no longer be able to rely on EDs for quality and timely emergency care, placing the safety of people at risk.8 In addition, Derlet has stated that should there be a major infectious disease epidemic or national catastrophe, EDs and hospitals could not accommodate the demand, undoubtedly leading to increased suffering and excess mortality.3

For all patients, increasing the capacity of the hospitals across the system (viz beds) would really make a difference.