Health Policy/Brief research reportEmergency department crowding: A point in time*,**,*
Introduction
Emergency department (ED) crowding is an increasing problem nationally. EDs serve as the health care safety net. Recently, there has been a perception that EDs are crowded, their ability to respond quickly to a mass casualty event is hampered, and our safety net is imperiled. Recent studies have shown that nationally, 91% of ED directors reported crowding to be a problem.1 Nearly 40% reported crowding on a “daily” basis.1
To date, most studies of ED conditions have relied on a historical perspective of crowding. We performed a pilot study of the point prevalence of crowding in US EDs. We prospectively measured the point prevalence of both physical crowding and personnel availability at an index time (March 12, 2001; 7 PM local time) designed to reflect a typical Monday evening.
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Materials and methods
This was a mail survey with prospective data collection at a point in time (7 PM local time on Monday, March 12, 2001 [index time]) and retrospective collection of data for the week before the index time. The study population was a random sample of 250 EDs chosen from a database compiled by the American College of Emergency Physicians (ACEP) of 5,064 EDs within the United States. The survey was addressed to the ED medical director; it did not specify who should complete it. ACEP distributed
Results
Eighty-nine surveys were returned, for a response rate of 36%. The western region accounted for 14% of surveys, the northern region for 15%, the southern region for 34%, and the midwest for 35%. Two surveys failed to give information identifying their state. The remaining information from these surveys was used. Demographic characteristics of respondents are given in Table 1.Characteristics Mean Range No. No. of ED visits/y 29,900 6,000-116,000 88 No. of ED
Discussion
There was physical crowding in the majority of responding EDs. On this typical Monday evening, more than 100% of the treatment spaces in the EDs were occupied. Crowding was present in all regions and in all types of hospitals (public versus private, academic-teaching versus nonteaching). Our findings are similar to those of Derlet et al,1 who found that 91% of ED directors reported crowding to be a problem. That study showed similar results in teaching-nonteaching hospitals and in large and
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The authors report this study did not receive any outside funding or support.
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Address for reprints: Sandra M. Schneider, MD, Department of Emergency Medicine, University of Rochester, 601 Elmwood Drive, Box 655, Rochester, NY 14642; 716-275-9490, fax 716-473-3516;,E-mail [email protected].
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Author contributions: SMS conceived the study. SMS, MEG, and RS designed the methodology. MEG conducted the survey. SMS and FLZ analyzed the data. SMS, FLZ, RS, and MEG drafted specific areas of the manuscript and edited the manuscript. SMS takes responsibility for the paper as a whole.