Frequent overcrowding in US emergency departments

Objective: To describe the definition, extent, and factors associated with overcrowding in emergency departments (EDs) in the United States as perceiv ed by ED directors. Methods: Surveys were mailed to a random sample of EDs in all 50 states. Questions included ED census, frequency, impact, and dete rmination of overcrowding. Respondents were asked to rank perceived causes using a five-point Likert scale. Results: Of 836 directors surveyed, 575 (6 9%) responded, and 525 (91%) reported overcrowding as a problem. Common def initions of overcrowding (>70%) included: patients in hallways, all ED beds occupied, full waiting rooms >6 hours/ day, and acutely ill patients who w ait >60 minutes to see a physician. Overcrowding situations were similar in academic EDs (94%) and private hospital EDs (91%). Emergency departments s erving populations less than or equal to 250,000 had less severe overcrowdi ng (87%) than EDs serving larger areas (96%). Overcrowding occurred most of ten several times per week (53%), but 39% of EDs reported daily overcrowdin g. On a 1-5 scale (+/-SD), causes of overcrowding included high patient acu ity (4.3 +/- 0.9), hospital bed shortage (4.2 +/- 1.1), high ED patient vol ume (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. Conclusions: Episodic , but frequent, overcrowding is a significant problem in academic, county, and private hospital EDs in urban and rural settings. Its causes are comple x and multifactorial.