Emergency department crowding: A point in time

doi:10.1067/mem.2003.258

Annals of Emergency Medicine

Volume 42, Issue 2, August 2003, Pages 167-172

https://doi.org/10.1067/mem.2003.258 Get rights and content

Abstract

Study objective: This is a pilot study designed to assess the feasibility of a point prevalence study to assess the degree of crowding in hospital emergency departments (EDs). In addition, we sought to measure the degree of physical crowding and personnel shortage in our sample. Methods: A mail survey was sent to a random sample of 250 EDs chosen from a database compiled by the American College of Emergency Physicians of 5,064 EDs in the United States. In addition to demographic information, respondents were asked to count the patients and staff in their EDs at 7 PM local time on Monday, March 12, 2001 (index time). Results: The response rate was 36%. At the index time, there was an average of 1.1 patients per treatment space, and 52% of EDs reported more than 1 patient per treatment space. There was also evidence of personnel shortage, with a mean of 4.2 patients per registered nurse and 49% of EDs having each registered nurse caring for more than 4 patients. There was a mean of 9.7 patients per physician. Sixty-eight percent of EDs had each physician caring for more than 6 patients. There was crowding present in all geographic areas and all hospital types (teaching-nonteaching status of the hospital). Consistent with the crowded conditions, 11% of institutions were on ambulance diversion and not accepting new acute patients. Delays in transfer of admitted patients out of the ED contributed to the physical crowding. Twenty-two percent of patients in the ED were already admitted and were awaiting transfer to an inpatient bed; 73% of EDs were boarding 2 or more inpatients. The amount of crowding quantified by this point prevalence study was confirmed by the amount of crowding reported for the previous week: 48% of EDs were boarding inpatients during the previous week for a mean of 8.9 hours, 4.2 days per week; 31% had been on diversion; 59% had been routinely using their halls for patients; 38% had been doubling their rooms; and 47% had been using nonclinical space for patient care. Conclusion: Our low response rate limits this pilot study. Nonetheless, this study, as well as others, demonstrates that EDs throughout the United States are severely crowded. Such crowding raises concerns about the ability of EDs to respond to mass casualty or volume surges. [Ann Emerg Med. 2003;42:167-172.]

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.

Section snippets

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.

. Demographic characteristics of responding EDs.

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.

^**: 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].

^*: 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.

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Health Policy/Brief research reportEmergency department crowding: A point in time*,**,*

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Am J Emerg Med

Ann Emerg Med

Frequent overcrowding in US emergency departments

Acad Emerg Med

Emergency center categorization

Program Requirements for Residency Education in Internal Medicine

When the safety net is unsafe: a real time assessment of the overcrowded emergency department

Acad Emerg Med

Health Policy/Brief research report
Emergency department crowding: A point in time*,**,*