Emergency Department Overcrowding

Emergency Department Overcrowding: Problem Description

Emergency departments (EDs) provide care to people suffering from “unexpected illness or injury”, and serve as a round-the-clock “safety net” (p. 846), to any and all that require immediate care (Derlet & Richards, 2002). According to Krug (2004), there has been a steady increase in the “volume and acuity of patient visits to EDs” (an increase of over 600% since 1958), resulting in a “phenomenon . . . referred to as ED overcrowding” (p. 878). As a result, those that are in the most need of emergency services are at an increased risk of having access problems. ED overcrowding affects both urban and rural areas, as well as public and private hospitals (Derlet & Richards, 2002).

ACEP defines ED overcrowding as a “situation in which the identified need for emergency services, outstrips available resources in the ED” (Krug, 2004, p. 881). It is a symptom of failure on the part of the health care system as a whole. In fact, according to Derlet and Richards, most factors contributing to overcrowding are “associated with services beyond the control of the ED” (p. 848). This includes a shortage of hospital beds leading to the ED serving as a type of boarding area for patients waiting to be admitted. Also, overall access problems by the unemployed and uninsured populations make hospital EDs, in essence, the “only place . . . [where] all patients are guaranteed medical care . . . regardless of economic or social status and without an appointment” (Krug, 2004, p. 879).

According to Trzeciak and Rivers (2003), overcrowding has reached crisis proportions, with more than “90% of large hospitals operating ‘at’ or ‘over’ capacity” (p. 403), and is becoming a severe threat to patient safety and public health. This jeopardizes “the reliability of the entire US emergency care system” (p. 402).

Emergency Department Overcrowding: Implications

According to Krug (2004), overcrowding puts both patients and health care professionals at risk. Less time spent with patients increases medical errors and poor outcomes, and lowers overall patient satisfaction. Long wait times lead to prolonged pain and suffering for patients in uncomfortable environments. Ofc. Hoffman of the Riviera Beach Police Department claims that there is no better local hospital for emergency care than St. Mary’s (West Palm Beach, FL) and that most officers wish to be transported there in case of an emergency. However, on days that there is overcrowding, the staff is harried and care is ambivalent at best, even for injured officers (personal communication, November 22, 2014). On the extreme edge of the spectrum, overcrowding results in “death, permanent disability, additional procedures, and increased length of hospitalization” (Derlet & Richards, 2002, p. 846).

Many ED physicians report extreme frustration as a result of overcrowding preventing them from doing their jobs optimally. Dr. Snarski of Gardens Hospital Emergency Department (Palm Beach Gardens, FL) claims that the biggest source of overcrowding is a lack of access to Primary Care Physicians (PCPs), leading to many people using the ED for non-emergency situations. According to her, the ACA has helped somewhat, but there are many reports of patients being assigned PCPs nowhere near to where they live. This often leads to ambulance diversion and takes away from service and care to patients that really need it (personal communication, November 18, 2014).