New joint WHO/Europe and European Observatory report outlines policy options to strengthen emergency care in hospitals

A new report released jointly by WHO/Europe and the European Observatory on Health Systems and Policies sets out practical policy options to help countries address mounting pressures on urgent and emergency care in hospitals across the WHO European Region.

The report, "Dealing with the challenges in urgent and emergency care: what are the policy options?", examines how countries can better organize, staff and coordinate services to ensure patients receive timely, high-quality care - while avoiding unnecessary strain on hospitals.

A central message of the report is that urgent and emergency care performance depends on system-wide planning and coordination.

"Urgent and emergency care cannot be fixed by focusing on one part of the system alone. Policy-makers must take a whole-of-system view - aligning incentives, investing in the health workforce and strengthening primary care so that people receive the right care, in the right place, at the right time," said Dr Natasha Azzopardi-Muscat, WHO/Europe's Director of Health Systems.

Systems that build trust

Health services are delivered in a range of settings, from community and primary care to ambulance services and hospital emergency departments. Urgent and emergency care is designed for patients who need prompt attention, with emergency care treating the most serious and life-threatening conditions.

Getting urgent and emergency care right is critical to achieving quality outcomes, maintaining public confidence in the health system and reducing the overuse of hospital services.

"How a health system performs under pressure tells you a great deal about its underlying strengths and weaknesses," said Dr Ewout van Ginneken, Director of the European Observatory. "Urgent and emergency care sits at the intersection between these strengths and weaknesses, and reform in this space involves real trade-offs, where some interventions can shift demand without resolving the root causes. By mapping the policy options, this policy brief gives policy-makers the evidence they need to build systems that people trust and that respond effectively when it matters most."

Why primary care is often bypassed

The report highlights that, in principle, primary care should be the first point of contact for most urgent care needs. Yet in many countries, patients bypass primary care and seek help directly from hospital emergency departments.

This can happen for several reasons:

• insufficient capacity to offer same-day appointments or out-of-hours services;
• difficulties recruiting and retaining family doctors and other primary care staff;
• lack of public confidence in the quality of primary care; and
• system incentives that unintentionally encourage hospital use, such as co-payments for primary care but not for emergency care.

The authors note that stronger, accessible and trusted primary care is key to improving how urgent care is used.

Bridging models and ambulance services

Some systems have introduced minor injury units or walk-in centres as an additional layer between primary care and hospitals, including out-of-hours services to relieve pressure on emergency departments.

While these models can improve access and reduce bottlenecks, the report cautions that they may also sideline primary care or generate additional demand if not carefully designed and integrated.

Ambulance services are another critical component of emergency provision. The report underscores the need for:

• the capability to assess and treat patients at the scene, including making informed decisions about when hospital transport is not required;
• safe and well-organized handover arrangements at hospitals;
• integration with the wider health system, including access to patient records and remote specialist advice; and
• appropriate staffing, including well-trained paramedics.

Hospital emergency departments: key enablers

Hospital emergency departments can bring together the right skills and resources in one place. But they are costly and complex to set up.

The report highlights that they work best when there is:

• a dedicated team of well-trained doctors and nurses;
• appropriate facilities and clear internal organization; and
• strong connections with other hospital departments and community services to ensure patients receive continuous care.

System-wide planning and smarter incentives

As the report notes, improving urgent and emergency care requires better system-wide coordination. Better patient flows and stronger integration depend on evidence-based service design, an understanding of how people use services, attention to local context and public expectations, and smarter resource allocation.

Workforce planning is equally critical. Countries need the right mix of skills, supported by appropriate incentives and training for primary care professionals - particularly in remote areas - as well as for paramedics and emergency medicine specialists where needed.

Building public trust

The report emphasizes that improving public trust in the health system - particularly in primary care - can significantly influence how services are used. Clear communication about how the system works and when to seek different types of care helps ensure that patients access the most appropriate services.

"Emergency services are often the pressure valve of wider health system challenges," said Dr Tomas Zapata, WHO/Europe Regional Adviser for Health Workforce and Service Delivery, and one of the brief's authors. "Strengthening urgent care therefore means addressing workforce capacity, access to primary care and system coordination as part of a broader reform effort that contributes to build public trust."