Survey of directors of emergency departments in California on overcrowding

Objective To survey the directors of emergency departments in California on their opinions of the extent and factors associated with overcrowding in e mergency departments. Methods Surveys were mailed to a random sample of eme rgency department directors. Questions included estimated magnitude, freque ncy, causes, and effects of overcrowding. Results Of 160 directors surveyed , 113 (71%) responded, and 109 (96%) reported overcrowding as a problem. Al l (n = 21) university or county hospital directors and most (n = 88 [96%]) private or community hospital directors reported overcrowding. The 4 privat e or community hospital directors reporting no overcrowding serve smaller c ommunities with populations less than 250,000. Thirty-two directors (28%) r eported daily overcrowding. The most cited causes were increasing patient a cuity and volume, hospital bed shortage, laboratory delays, and nursing sho rtage. These putative causes were similar between university or county and private or community hospital directors, except for consultant delays, whic h were more prevalent in university or county hospital emergency department s. Conclusions Overcrowding is perceived to be a serious problem by emergen cy department directors. Many factors may contribute to overcrowding, and m ost are beyond the control of emergency departments.