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SUMMARY
Overcrowding in emergency departments is a problem
in many countries around the world, including the
United States and Chile. Emergency department (ED)
overcrowding causes problems for patients and staff,
including increased waiting times, increased ambulance
diversion, increased length of stay, increased medical
errors, increased patient mortality, and increased harm
to hospitals due to financial losses. This article aims to
describe the etiology of ED overcrowding and potential
solutions through an examination of the evidence.
Ultimately, ED overcrowding originates from hospital
overcrowding and thus the solutions to this complex
problem lie in the ED itself as well as outside of the ED.
Key words: Overcrowding, hospital operations, emer-
gency department, emergency medicine
INTRODUCTION
The media has recently given great attention to the “crisis”
in emergency department (ED) overcrowding in the United
States, as if this were a recent development. As far back as
EMERGENCY DEPARTMENT (ED)
OVERCROWDING: EVIDENCE-BASED
ANSWERS TO FREQUENTLY ASKED
QUESTIONS
SALWAY RJ MD (1), VALENZUELA R MD (1),SHOENBERGER JM MD (2), MALLON WK MD (1), VICCELLIO A MD (1)
(1) Professor of Emergency Medicine Stony Brook University School of Medicine Director, Division of International Emergency Medicine
Department of Emergency Medicine.
Stony Brook University (SUNY), Division of International Emergency Medicine, Stony Brook, NY.
(2) Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, CA.
Email:
wkmallonmd@gmail.comArtículo recibido: 02-01-2017
Artículo aprobado para publicación: 01-03-2017
1987, after sustained and unsolvable problems with over-
crowding, the first statewide conference on overcrowding
was held in New York City, involving the New York (NY)
chapter of the American College of Emergency Physicians
(ACEP), New York Emergency Medical Services (EMS), the NY
State Department of Health, and state legislators. At that
time the issue was clearly delineated, but no clear solutions
were forthcoming. Since that time, hospital and ED over-
crowding has enjoyed cyclical media attention, but with
little done to “fix” the problem.
How did it reach this point?
Hospitals in the 1960’s were, in large part, a place for elective
admissions, with only a small percentage of patients being
unscheduled, or “emergent.” There was also substantial
capacity to allow for system-wide inefficiencies. During this
time, hospitals were run primarily as a 9am-5pm, Monday
through Friday business, with a skeleton crew staffing the
hospital during evenings, nights and weekends. Average
length of stay (LOS) exceeded 12 days, so the medical model
of rounding once a day was appropriate.
Over the past 30 years, a dramatic change has occurred.
The majority of admissions are now unscheduled. As many