Patience Lost in Overcrowded ERs
Feb. 25, 2000 (Lake Worth, Fla.) -- Crisis is brewing in the nation's
emergency rooms, an article in the January issue of the Annals of Emergency
Medicine reports. Patients may not always be able to rely on their
emergency department (ED) for quality care and timely treatment, say
researchers from the University of California, Davis, who conducted the
While this news may spur some people to stay home and hope their chest pain
will go away on its own, John R. Richards, MD, one of the study's authors,
tells WebMD this is the last thing he would want patients to do.
"But at the same time, [patients should] realize that the problems are
getting worse and if there is a long wait and people seem to be rushing around
and seem impersonal, [don't] be critical, because we try our best." Sickest
patients are always seen first, he explains, "but too many sick patients
bring things to a standstill."
Richards, who is assistant professor of emergency medicine at UC-Davis, and
his colleague Robert W. Derlet, MD, conducted a survey among many of the
They found a laundry list of causes for the overcrowding, such as more
chronic illnesses; a shortage of nursing and administrative staff; managed care
patients being forced to use the ED because their specified primary care
physician or clinic is too busy; more patients being treated in the ED instead
of being admitted to the hospital; and delays caused by other departments, such
as laboratory and radiology.
They also found that ED overcrowding is not confined to urban hospitals --
rural hospitals' EDs are packed as well.
The overcrowding has resulted, among other things, in poor patient care,
decreased staff productivity, ambulances being diverted to other hospitals, and
violence, Richards' article notes.
Adding to these problems, Michael T. Rapp, MD, president of the American
College of Emergency Physicians (ACEP), tells WebMD that during the last few
years many hospitals have closed their doors. "Yet the demand hasn't gone
down," he says, explaining that emergency rooms handle about 100 million
visits every year. And only a few patients were admitted to the hospital
through the ED 20 years ago, Rapp says. Now nearly 50% of them are.
There are always seasonal factors, such as flu, adding to the bustle. This
year, the problem was worse than usual, Rapp says. "It seems like we've
pretty much wrung the excess capacity out of our health care system. What we
have is kind of the straw breaking the camel's back," he says.
The other problem, Richards says, is that if a hospital is full, patients
have to wait in the ED until they can be admitted to the hospital. "We end
up being a de facto intensive care unit with people who are getting very
comprehensive care," he says. This adds to waiting times for less seriously
ill patients. "If you have a broken ankle, you're going to wait
awhile," he says.