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Source: Derlet RW, et al. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151-155.
Derlet and colleagues recently published the results of a national survey of overcrowding in the emergency department (ED). Surveys were sent by mail to 836 randomly selected ED directors in all 50 states. The directors were asked to rate the severity of overcrowding in their ED, the frequency of overcrowding episodes, and the perceived causes of the problem. The respondents were asked to characterize the term "overcrowding" by wait time, bed availability, or physician workload. The directors also were asked to characterize the demographics of their population base and the characteristics of their ED.
Sixty-nine percent of the ED directors surveyed returned the questionnaire. Ninety-one percent reported overcrowding to be a problem. While overcrowding was more prevalent in EDs serving communities of 250,000 or more, it was still reported to be extremely common (87% prevalence) in EDs serving smaller populations. Overcrowding was reported with equal frequency by directors of academic, county, and private EDs. It was related to be a daily problem by 39% of directors. As related to overcrowding, two-thirds of respondents reported concern for risk of poor patient outcome and one-third reported actual instances of adverse events.
The most commonly perceived causes of overcrowding were (in order of mean importance): increased patient acuity, hospital bed shortages, increased ED volume, laboratory and radiology delays, and inadequate ED space. Interestingly, more than one-half of respondents reported that ED overcrowding had developed only within the preceding three years. The authors conclude that frequent, episodic overcrowding is a significant problem in all types of EDs.
Comment by David J. Karras, MD, FAAEM, FACEP
Although ED overcrowding seemed to disappear from the national radar in the mid-1990s, the issue once again has gained considerable media attention. Unfortunately, most of our information about this issue is based on anecdotal evidence, and there have been no recent studies of the scope or magnitude of the problem. Derlet and colleagues recognize that ED overcrowding cannot be addressed until it is quantified, and this survey is the first recent, large-scale effort to amass objective data regarding the problem.
Although this study was carefully executed and the response rate is excellent for a mail-in questionnaire, the authors acknowledge a number of limitations inherent to this type of research. There is, foremost, no uniform definition of "overcrowding." Directors were asked to define the problem themselves and to relate their perception of its magnitude. In addition, there was no attempt to verify the accuracy of the information provided. Despite these shortcomings, Derlet’s study clearly documents the perception of a national health care crisis and puts the issue clearly on the table for future research and efforts at reform.