Patience Lost in Overcrowded ERs
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.
In an accompanying editorial titled DÃ©jÃ vu, Arthur L. Kellerman, MD,
calls upon ACEP to "once again make ED overcrowding a priority."
Kellerman was part of an ACEP-convened task force that tackled this issue 10
Rapp says, "One of the things [ACEP] did do lately [was gather]
information about what's going on in the emergency departments and,
specifically, what they are experiencing in reference to the general issue of
The public should continue to have confidence in the EDs because the
problems that are causing overcrowding are being addressed, he says. Although
the situation is not ideal or optimal, hospitals are making adjustments to meet
the demand. Expanding emergency services is one way to address the current
crisis, both Richards and Rapp say.
"I don't think the population as a whole should be alarmed," Rapp
says. "But I think they should be concerned."
Patients should realize, Richards says, that if their illness can be treated
by their primary care physician instead of the ED, going to their own physician
would be their best option.
- A survey of hospital emergency departments shows that overcrowding is
getting worse, and is prevalent among both urban and rural hospitals.
- Reasons for overcrowding include more chronic illnesses; a shortage of
nursing and administrative staff; managed care patients being forced to use the
emergency department because their specified primary care physician or clinic
is too busy; more patients being treated in the emergency department instead of
being admitted to the hospital; and delays caused by other departments, such as
laboratory and radiology.
- Patients should attempt to see their primary care physician if a trip to
the emergency department is not required.