Emergency Department Crowding

Summary

In the United States, an ambulance is diverted to a different hospital every minute because emergency departments (ED) are overcrowded (Stobbe, 2006). Ninety-one percent of surveyed ED directors across the United States reported emergency department crowding as a problem (Derlet, Richards, & Kravitz, 2001). The Emergency Nurses Association (ENA) does not support holding/boarding in the ED because this practice is not in the best interest of patients. It believes that “when emergency department crowding occurs, the number of patients in need of care outweighs the availability of resources, potentially resulting in diminished quality and safety of patient care and increased stress and dissatisfaction of staff. (Emergency Nurses Association Position Statement: Crowding in the Emergency Department)

ED crowding is a multifaceted problem that will require a multifaceted solution (Bradley, 2005). Due to its complexity, a large concerted group effort will be needed to increase awareness, implement proposed solutions, and make a change. ENA recommends policy change to ensure safe and effective emergency care by eliminating ED crowding. These policies will require long-term goals involving collaborative efforts among state and federal legislators, regulatory agencies, hospitals, health care policymakers, health care providers, and community leaders.

In June 2006, the Institute of Medicine (IOM) released a series of three reports that look at hospital-based emergency and trauma care, pre-hospital emergency medical services, and the special challenge of offering emergency care to pediatric patients. These reports identify what the IOM feels are the most important issues facing the emergency care system, which include the issue of crowding. The IOM recommends a multi-pronged strategy which includes improving hospital efficiency and patient flow; having in place a coordinated, regionalized, accountable system; increasing resources; and paying attention to children. (The Future of Emergency Care in United States Health System" by the Institute of Medicine).

A brief summary of the IOM report and other key articles containing information on the causes, effects, and proposed solutions of emergency department crowding can be found by clicking on the links below.

Key Resources

Access to Care

Emergency Department Diversion

Hospital Systems

Policy

Technology

Other Information Sources

Special thanks to Windsor Reeve, MSN, RN, CNS, ENP for the research and primary development of this web content. This project was undertaken as part of a fellowship arrangement between ENA and The University of Texas Health Sciences Center at Houston.