A&E Under Pressure: Preventing Patient Harm and Pressure Ulcers in Overcrowded Emergency Departments

The first in our series of blogs to support #StopThePressure week - Overcrowding, staff shortages, and rising demand are straining Accident & Emergency departments. Discover how these challenges contribute to patient harm — and what can be done to prevent it

Background: Why Focus on Accident & Emergency?

Emergency department (ED) attendance continues to rise every year, placing unprecedented strain on the NHS and healthcare systems (NHS England South East, Undated).

This intense pressure has led to overcrowding, limited patient spaces, and the use of temporary escalation areas, sometimes referred to as “corridor care” (NHS England, 2024).

Staffing challenges compound the issue. Vacancies remain unfilled, morale is low, and staff fatigue is widespread. A recent Health Services Safety Investigation Body (2025) report confirmed that fatigue contributes both directly and indirectly to patient harm.

The Link Between A&E Pressures and Pressure Ulcers

A systematic review by Sardo et al. (2023) found that managing pressure ulcers in emergency care remains a persistent challenge. NHS Resolution (2022) identified Emergency Medicine as one of the top specialties for new harm claims over the past decade, reflecting both the demand and the growing complexity of patients seen in EDs.

Research by Liu et al. (2017) shows that patients over 60 years old account for nearly 24% of all ED visits globally. These patients often have multiple comorbidities, reduced mobility, and spend longer periods in the department — all of which increase their risk of pressure injuries.

Why Patients Develop Pressure Ulcers in A&E

Several factors in emergency care environments contribute to the development of pressure ulcers:

  • Restricted mobility: Patients are often placed on narrow trolleys with cot sides for safety, limiting repositioning.
  • Prolonged immobilisation: Trauma patients may be strapped to spinal boards or wear cervical collars, increasing the risk of device-related ulcers.
  • Pain and discomfort: High pain levels discourage movement and repositioning.
  • Limited equipment suitability: Trolleys are narrower and shallower than beds, restricting repositioning and skin inspection.
  • Environmental barriers: Escalation spaces may reduce patient dignity, limit access to hygiene facilities, and increase reliance on incontinence products.
  • Nutrition and hydration delays: Patients may be kept nil by mouth for extended periods before diagnosis or treatment.
  • Communication challenges: Patients may be confused, distressed, or unable to provide accurate medical histories.

Accountability Gaps in Emergency Care

Patients in EDs may not yet be “admitted” to hospital care, creating ambiguity over responsibility if harm occurs. If a pressure ulcer develops before admission, it can be unclear whether community teams or the hospital should record and address it.

Most Common Pressure Ulcer Sites in A&E

Sardo et al. (2023) identified that:

  • The majority of ED-acquired pressure ulcers are Category I.
  • The sacrococcygeal region and heels are most frequently affected.
  • Trauma patients immobilised with headblocks and cervical collars often develop ulcers on the chest, back, and shoulders.

Conclusion: Balancing Life-Saving Care with Harm Prevention

While preventing long-term harm may seem secondary to saving lives, both are essential priorities. Overcrowded, high-pressure environments should still have systems in place to protect patient skin health and safety.

Key actions include

  • Embedding consistent skin assessment and repositioning processes.
  • Investing in equipment that supports both safety and comfort.
  • Designing spaces that protect dignity and facilitate care delivery.

Upcoming Event

Our upcoming webinar – From Pressure to Prevention: Rethinking Ulcer Care in Emergency Settings will focus on understanding the barriers, perspectives, and collaborative solutions shaping pressure ulcer care across ED and ambulance pathways,

Find out more and register for FREE

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