Abstract
Emergency Department (ED) crowding and ambulance diversion have been increasingly
significant national problems for more than a decade. Surveys of hospital directors
have reported overcrowding in almost every state and 91% of hospital ED directors
report overcrowding as a problem. The problem has developed because of multiple factors
in the past 20 years, including a steady downsizing in hospital capacity, closures
of a significant number of EDs, increased ED volume, growing numbers of uninsured,
and deceased reimbursement for uncompensated care. Initial position statements from
major organizations, including JCAHO and the General Accounting Office, suggested
the problem of overcrowding was due to inappropriate use of emergency services by
those with no urgent conditions, probably cyclical, and needed no specific policy
response. More recently, the same and other organizations have more forcefully highlighted
the problem of overcrowding and focused on the inability to transfer emergency patients
to inpatient beds as the single most important factor contributing to ED overcrowding.
This point has been further solidified by initial overcrowding research. This article
will review how overcrowding occurred with a focus on the significance and potential
remedies of extended boarding of admitted patients in the Emergency Department.
Keywords
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Article info
Publication history
Accepted:
May 2,
2005
Received in revised form:
February 9,
2005
Received:
April 26,
2004
Footnotes
Administration of Emergency Medicine is coordinated by Eugene Kercher, md, of Kern Medical Center, Bakersfield, California and Richard F. Salluzzo, md, of Conemaugh Meridian Health Group, Johnstown, Pennsylvania
Identification
Copyright
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
