Emergency department overcrowding and mortality after the introduction of the 4-hour rule in Western Australia

To the Editor: We would like to congratulate Geelhoed and de Klerk1 for reporting the expected decreases in emergency department (ED) overcrowding following introduction of the 4-hour rule in Western Australia. Their study highlighted potential adverse effects and inflated demand across hospital systems — specifically, concerns regarding patient safety and junior medical staff training; significantly higher proportions of admitted patients (39.6% to 49.1%); and incomplete assessment and management in EDs, underscored by “more . . . investigations occurring on the wards”.