Elsevier

Annals of Emergency Medicine

Volume 20, Issue 9, September 1991, Pages 980-986
Annals of Emergency Medicine

Original contribution
Emergency departments and crowding in United States teaching hospitals

https://doi.org/10.1016/S0196-0644(05)82976-2Get rights and content

Study objectives:

To assess the extent and distribution of hospital and emergency department crowding nationally.

Design:

The research design consisted of a mailed questionnaire disseminated in the fall of 1988 to the member institutions of the National Association of Public Hospitals (NAPH) and the Council of Teaching Hospitals (COTH).

Type of participants:

Study participants included hospital administrators and ED directors from 239 of the non-Veterans Administration, general acute care, US members of COTH and NAPH.

Measurements:

Key measures of hospital and ED crowding including mean ED holding times for floor and ICU beds.

Main results:

Three fourths of responding hospitals reported increases in ED visits over the preceding three years. Mean ED holding times for admitted patients were 3.5 hours (median, 2.0 hours) for a floor bed and 2.9 hours (median, 1.5 hours) for an ICU bed. Half of all hospitals noted maximum waits for floor and ICU beds of ten hours or more and seven hours or more, respectively. Measures taken by hospitals to manage crowding during August 1988 included restricting access to some types of patients (mean, 3.6 days), actively transferring patients to other hospitals (mean, 2.2 days), transfer refusal (mean, 2.8 days), and total ambulance diversion (mean, 1.6 days).

Conclusions:

Our study strongly suggests that ED crowding is not an isolated phenomenon; ED crowding and its attendant problems appear to affect hospitals with similar adverse effects regardless of ownership. Although our results suggest that ED crowding is concentrated in metropolitan areas and in a smaller subset of hospitals, we found instances of crowding among hospitals nationwide.

References (24)

  • Emergency room gridlock: On the verge of crisis

    New York Times

    (September 17, 1989)
  • FrenchH

    Emergency rooms overwhelmed as New York's poor get sicker

    New York Times

    (December 19, 1988)
  • KahnR

    Gridlock in the emergency room

    Boston Sunday Herald

    (June 25, 1989)
    KahnR

    Gridlock in the emergency room

    Boston Sunday Herald

    (June 25, 1989)
    KahnR

    Gridlock in the emergency room

    Boston Sunday Herald

    (June 25, 1989)
  • AckerC et al.

    Hospital crowding sends mental patients to jail

    Philadelphia Enquirer

    (September 24, 1989)
  • GarciaK

    Prognosis gloomy for trauma network

    Los Angeles Times

    (April 10, 1990)
  • MullenK et al.

    City warns of disaster at hospitals

    Dallas Times Herald

    (December 12, 1989)
  • HillenS

    Emergency room care straps public hospitals: Intensive care beds in short supply in Kansas City, across the country

    Kansas City Times

    (September 25, 1989)
  • GibbsN

    Do you want to die?

    Time

    (May 28, 1990)
  • WillG

    The trauma in trauma care

    Newsweek

    (March 12, 1990)
  • MelnickGA et al.

    Uncompensated emergency care in hospital markets in Los Angeles County

    Am J Public Health

    (1989)
  • ThorpeKE

    The current hospital crisis in New York City and policy options for resolving it

    N Y State J Med

    (1990)
  • Patient Overload and Ambulance Diversion Report and Recommendations

    (1989)
  • Cited by (202)

    • Fitting aggregated phase-type distributions to the length-of-stay in intra-hospital patient transfers

      2021, Operations Research for Health Care
      Citation Excerpt :

      The ED is a specialized medical treatment unit which deals with emergency medicine, the acute care of patients without the need of prior appointment. It is suggested in [13–15] that ED crowding is not an isolated phenomenon and appears to affect hospitals nationwide. Patients are evaluated and treated in the ED, and further treatments depend on their conditions.

    • Managing emergency department crowding through improved triaging and resource allocation

      2016, Operations Research for Health Care
      Citation Excerpt :

      The emergency department (ED) is often the starting point for patient flow through a hospital for unscheduled urgent care, and it is a critical bottleneck [1]. Crowding, long waiting times, and queues are well-known problems in many EDs globally [2,3]. Long waiting times not only reduce patients’ perceived quality of care, but also increase crowding which can adversely affect patients’ outcomes [4].

    • Emergency department design

      2016, Ciottone's Disaster Medicine
    View all citing articles on Scopus

    Presented at the Society for Academic Emergency Medicine Annual Meeting in Minneapolis, Minnesota, May 1990.

    Financial support for this project was provided by the Robert Wood Johnson Foundation under grant no. 15263.

    View full text