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Emergency Room Overcrowding
Healthcare reform must take emergency room overcrowding into account.
Emergency room overcrowding is characterized by a dual phenomenon:
There are actual increases in the number of patients seeking treatment.
There is also a reduction in staff and hospital resources.
Actual definitions of emergency room overcrowding include long wait times, lack of available beds, and boarding patients.
Boarding patients is both the cause and effect of emergency room overcrowding, and hospital administrators and policy makers alike must work together for solutions.
The causes of emergency room overcrowding are multifaceted.
Staff shortages are a major problem for hospitals.
Emergency physicians contend with skyrocketing liability insurance.
Nursing shortages are also creating emergency room overcrowding.
B. Budget cuts have resulted in fewer emergency rooms being built and cost-cutting in existing ones.
C. Emergency room admissions procedures are woefully inefficient.
D. Hospitals lack effective protocol for dealing with maximum capacity emergency rooms.
E. There is a lack of legislative response so far.
F. The uninsured are increasingly using the ED for their non-emergency needs.
III. The effects of emergency room overcrowding can be deadly.
A. Boarding patients, or keeping already treated or stabilized patients in the ED, prevents patients from receiving the inpatient care they need.
B. Long wait times and inefficient service can mean loss of life
IV. Possible solutions demand health care system overhaul.
A. More efficient hospital registration would streamline emergency room procedures.
B. Standing orders would allow nurses and EMTs to proceed on critical care without doctors.
C. Special fast-track and sub-waiting areas would alleviate hallway overcrowding.
D. Re-budgeting will allocate more funds to emergency admissions.
E. Reducing non-urgent visits via universal healthcare initiative would reduce unnecessary use of the emergency room.
F. Increasing hospital capacity for acute inpatient needs would replace boarding.
G. Hospitals can add support staff during critical hours.
But let's look at this resolution in a bit more depth. Briefly, processes like full capacity protocols, bedside registration, bypassing triage, adding staff during increased volume, setting up a separate "line" for treating simple fractures, lacerations, etc., establishing turn-around-time (TAT) goals for procedures and patients, can go a long way to begin to cure the problem of overcrowding (ACEP, 2008, p. 10). Full-capacity protocols. Here is a typical full-capacity protocol
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