for population growth, there has been a 60% fall from 4.8 public acute beds per 1000 population in 1983 to 2.5 per 1000 population (2.6 per 1000 including psychiatric beds). This includes an 18% decrease between 1995 -- 1996 and 2005 -- 2006. Excessive bed closures mean public hospitals with significant emergency demand are unable to operate with sufficient spare bed capacity. True average occupancy in many major urban public hospitals is 90 -- 95% and therefore peak demand commonly pushes occupancy over 100% :: Paul Cunningham: Inadequate acute hospital beds and the limits of primary care and prevention :: Can't disagree with the content. Perhaps, though, the point would get across more clearly if it was worded in a less ED-centric context? Instead of the "an ED is crowded when..." preface, "a _hospital_ is crowded when..." better illustrates the effect being felt at the ED level. It might stop people from thinking all we need are more ED beds to fix the solution... In reply to gun street girl, it is an ED overcrowding tool, not a hospital overcrowding tool, hence the ED-centricity. The output measures (number of boarders and time to ward(board) patients) are the factors relating to the rest of the hospital. If the use of a tool like this can identify times when overcrowding is being perpeutated by output factors then that will give data to demonstrate that it is occupancy/flow/management of the workload and patients in the rest of the hospital that needs action. @Kathy,