Frequent Overcrowding in U.S. Emergency Departments

TLDR

Overcrowding in emergency departments has complex, multifactorial causes. The study aimed to describe the definition, extent, and factors associated with ED overcrowding in the United States as perceived by ED directors. A survey of a random sample of EDs across all 50 states collected data on census, frequency, impact, and perceived causes of overcrowding through Likert‑scale questions. Among 575 respondents, 91% reported overcrowding, with common definitions including hallway patients, full beds, and long waits, and overcrowding was more severe in larger EDs, occurring several times per week (53%) or daily (39%), mainly attributed to high acuity, bed shortages, and volume, with 33% noting poor patient outcomes.

Abstract

To describe the definition, extent, and factors associated with overcrowding in emergency departments (EDs) in the United States as perceived by ED directors.Surveys were mailed to a random sample of EDs in all 50 states. Questions included ED census, frequency, impact, and determination of overcrowding. Respondents were asked to rank perceived causes using a five-point Likert scale.Of 836 directors surveyed, 575 (69%) responded, and 525 (91%) reported overcrowding as a problem. Common definitions of overcrowding (>70%) included: patients in hallways, all ED beds occupied, full waiting rooms >6 hours/day, and acutely ill patients who wait >60 minutes to see a physician. Overcrowding situations were similar in academic EDs (94%) and private hospital EDs (91%). Emergency departments serving populations < or =250,000 had less severe overcrowding (87%) than EDs serving larger areas (96%). Overcrowding occurred most often several times per week (53%), but 39% of EDs reported daily overcrowding. On a 1-5 scale (+/-SD), causes of overcrowding included high patient acuity (4.3 +/- 0.9), hospital bed shortage (4.2 +/- 1.1), high ED patient volume (3.8 +/- 1.2), radiology and lab delays (3.3 +/- 1.2), and insufficient ED space (3.3 +/- 1.3). Thirty-three percent reported that a few patients had actual poor outcomes as a result of overcrowding.Episodic, but frequent, overcrowding is a significant problem in academic, county, and private hospital EDs in urban and rural settings. Its causes are complex and multifactorial.