Flow model for emergency departments: putting the cart before the horse

The continuous flow model (or proactive flow model) transfers patients from the emergency department into wards irrespective of whether beds are free.1 It aims to be a solution to problems of bed occupancy, lack of ward discharges, overcrowded emergency departments, and ambulance handover—but which of these problems is it really trying to solve?The demands of the health and social care service far exceed its capacity, with the most substantial bottleneck being patients who are fit for discharge awaiting social care support.2 A proactive model used to increase bed capacity might have marginal success in the short term, but as it tackles neither demand nor community discharge capacity, surely those extra beds would be rapidly filled with limited improvement to flow. A proactive model is likely to contribute to “failure demand”3—an increased demand on our resources caused by unknown risks associated with moving patients to overcrowded wards (further fragmented care, falls,…
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