Administration of emergency medicine
Emergency Department overcrowding and ambulance diversion: The impact and potential solutions of extended boarding of admitted patients in the Emergency Department

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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.

Section snippets

Overcrowding

The issue of Emergency Department (ED) crowding and ambulance diversion first received national attention with sporadic reports in the late 1980s. It has become an increasingly significant national problem for more than a decade. Surveys of hospital directors have reported overcrowding in almost every state in the U.S. Daily overcrowding has been reported by 10–30% of hospitals surveyed. Over 90% of hospital ED directors reported overcrowding as a problem, resulting in: patients in hallways,

Future goals

The problem of ED crowding has clearly captured the attention of emergency physicians, hospital administration, major health care organizations, and government policymakers. The realization of the major significance of this problem clearly justifies the hope that the present dangerous situation can improve. But the fix is not an easy one and will require sustained, coordinated efforts and resources from all stakeholders.

Future goals are:

  • 1)

    Future research demonstrating

    • a)

      Adverse effects of

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  • Cited by (0)

    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

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