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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 Déjà 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 years ago.

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 overcrowding."

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.

Vital Information:

  • 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.
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