Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions

Annals of Emergency Medicine

Volumn 52, Issue 2, 2008, Pages

  Hoot, Nathan R ^a   Aronsky, Dominik ^a  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CROWDING; EMERGENCY CARE; EMERGENCY WARD; FINANCIAL MANAGEMENT; HEALTH CARE ACCESS; HEALTH CARE QUALITY; HOSPITAL BED CAPACITY; HOSPITAL BED UTILIZATION; INFLUENZA; MEDICAL LITERATURE; METHODOLOGY; MORTALITY; PATIENT ABANDONMENT; PERSONNEL MANAGEMENT; PRIORITY JOURNAL; REVIEW; SYSTEMATIC REVIEW; THERAPY DELAY;

EID: 48949116157     PISSN: 01960644     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.annemergmed.2008.03.014     Document Type: Review

References (115)

1. Yamane K. Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities (2003), US General Accounting Office, Washington, DC GAO-03-460
2. Committee on the Future of Emergency Care in the United States Health System. Hospital-Based Emergency Care: At the Breaking Point (2006), National Academies Press, Washington, DC
3. Gibbs N. Do you want to die?. The crisis in emergency care is taking its toll on doctors, nurses, and patients. Time (1990) 58-65 May 28
4. Barrero J. Hospitals get orders to reduce crowding in emergency rooms. New York Times (1989) 1-2 January 24
5. Goldberg C. Emergency crews worry as hospitals say, "No vacancy.". New York Times 39 (2000) December 17
6. Orenstein J.B. State of emergency. Washington Post B1 (2001) April 22
7. Jeffrey N.A. Who's crowding emergency rooms?. Right now it's managed-care patients. Wall Street Journal B1 (1999) July 20
8. Emergency Medical Treatment and Active Labor Act, established under the Consolidated Omnibus Budget Reconciliation Act of 1985. Pub L No. 99-272, 42USC 1395dd (1986).
9. Asplin B.R. Tying a knot in the unraveling health care safety net. Acad Emerg Med 8 (2001) 1075-1079
10. American Academy of Pediatrics Committee on Pediatric Emergency Medicine. Overcrowding crisis in our nation's emergency departments: is our safety net unraveling?. Pediatrics 114 (2004) 878-888
11. Kellermann A.L. Crisis in the emergency department. N Engl J Med 355 (2006) 1300-1303
12. Hwang U., and Concato J. Care in the emergency department: how crowded is overcrowded?. Acad Emerg Med 11 (2004) 1097-1101
13. Pham J.C., Patel R., Millin M.G., et al. The effects of ambulance diversion: a comprehensive review. Acad Emerg Med 13 (2006) 1220-1227
14. American College of Emergency Physicians. Crowding. Ann Emerg Med 47 (2006) 585
15. Sackett D.L., Haynes R.B., and Guyatt G.H. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. (1991), Little Brown, Boston, MA
16. Wang C.S., FitzGerald J.M., Schulzer M., et al. Does this dyspneic patient in the emergency department have congestive heart failure?. JAMA 294 (2005) 1944-1956
17. Landis J.R., and Koch G.G. The measurement of observer agreement for categorical data. Biometrics 33 (1977) 159-174
18. Asplin B.R., Magid D.J., Rhodes K.V., et al. A conceptual model of emergency department crowding. Ann Emerg Med 42 (2003) 173-180
19. Grumbach K., Keane D., and Bindman A. Primary care and public emergency department overcrowding. Am J Public Health 83 (1993) 372-378
20. Afilalo J., Marinovich A., Afilalo M., et al. Nonurgent emergency department patient characteristics and barriers to primary care. Acad Emerg Med 11 (2004) 1302-1310
21. Howard M.S., Davis B.A., Anderson C., et al. Patients' perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding. J Emerg Nurs 31 (2005) 429-435
22. Sprivulis P., Grainger S., and Nagree Y. Ambulance diversion is not associated with low acuity patients attending Perth metropolitan emergency departments. Emerg Med Australas 17 (2005) 11-15
23. Huang J.A., Tsai W.C., Chen Y.C., et al. Factors associated with frequent use of emergency services in a medical center. J Formos Med Assoc 102 (2003) 222-228
24. Andersen R.M. Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav 36 (1995) 1-10
25. Dent A.W., Phillips G.A., Chenhall A.J., et al. The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med (Fremantle) 15 (2003) 322-329
26. Glaser C.A., Gilliam S., Thompson W.W., et al. Medical care capacity for influenza outbreaks, Los Angeles. Emerg Infect Dis 8 (2002) 569-574
27. Schull M.J., Mamdani M.M., and Fang J. Influenza and emergency department utilization by elders. Acad Emerg Med 12 (2005) 338-344
28. Schull M.J., Mamdani M.M., and Fang J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 44 (2004) 61-67
29. Andersson G., and Karlberg I. Lack of integration, and seasonal variations in demand explained performance problems and waiting times for patients at emergency departments: a 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals. Health Policy 55 (2001) 187-207
30. Fatovich D.M., and Hirsch R.L. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J 20 (2003) 406-409
31. Baer R.B., Pasternack J.S., and Zwemer Jr. F.L. Recently discharged inpatients as a source of emergency department overcrowding. Acad Emerg Med 8 (2001) 1091-1094
32. Lambe S., Washington D.L., Fink A., et al. Waiting times in California's emergency departments. Ann Emerg Med 41 (2003) 35-44
33. Schneider S.M., Gallery M.E., Schafermeyer R., et al. Emergency department crowding: a point in time. Ann Emerg Med 42 (2003) 167-172
34. Schull M.J., Lazier K., Vermeulen M., et al. Emergency department contributors to ambulance diversion: a quantitative analysis. Ann Emerg Med 41 (2003) 467-476
35. Lambe S., Washington D.L., Fink A., et al. Trends in the use and capacity of California's emergency departments, 1990-1999. Ann Emerg Med 39 (2002) 389-396
36. Polevoi S.K., Quinn J.V., and Kramer N.R. Factors associated with patients who leave without being seen. Acad Emerg Med 12 (2005) 232-236
37. Davis B., Sullivan S., Levine A., et al. Factors affecting ED length-of-stay in surgical critical care patients. Am J Emerg Med 13 (1995) 495-500
38. Andrulis D.P., Kellermann A., Hintz E.A., et al. Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 20 (1991) 980-986
39. Fromm Jr. R.E., Gibbs L.R., McCallum W.G., et al. Critical care in the emergency department: a time-based study. Crit Care Med 21 (1993) 970-976
40. Fatovich D.M., Nagree Y., and Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 22 (2005) 351-354
41. Cooke M.W., Wilson S., Halsall J., et al. Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J 21 (2004) 575-576
42. Schull M.J., Szalai J.P., Schwartz B., et al. Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 8 (2001) 1037-1043
43. Forster A.J., Stiell I., Wells G., et al. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 10 (2003) 127-133
44. Hwang J.I. The relationship between hospital capacity characteristics and emergency department volumes in Korea. Health Policy 79 (2006) 274-283
45. Warden C.R., Bangs C., Norton R., et al. Temporal trends in ambulance diversion in a mid-sized metropolitan area. Prehosp Emerg Care 7 (2003) 109-113
46. Sun B.C., Mohanty S.A., Weiss R., et al. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med 47 (2006) 309-316
47. Derlet R.W., and Richards J.R. Emergency department overcrowding in Florida, New York, and Texas. South Med J 95 (2002) 846-849
48. Derlet R., Richards J., and Kravitz R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 8 (2001) 151-155
49. Richards J.R., Navarro M.L., and Derlet R.W. Survey of directors of emergency departments in California on overcrowding. West J Med 172 (2000) 385-388
50. Clark K., and Normile L.B. Delays in implementing admission orders for critical care patients associated with length of stay in emergency departments in six mid-Atlantic states. J Emerg Nurs 28 (2002) 489-495
51. Bazzoli G.J., Brewster L.R., Liu G., et al. Does U.S. hospital capacity need to be expanded?. Health Aff (Millwood) 22 (2003) 40-54
52. Miro O., Antonio M.T., Jimenez S., et al. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 6 (1999) 105-107
53. Richardson D.B. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 184 (2006) 213-216
54. Sprivulis P.C., Da Silva J.A., Jacobs I.G., et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 184 (2006) 208-212
55. Begley C.E., Chang Y., Wood R.C., et al. Emergency department diversion and trauma mortality: evidence from Houston, Texas. J Trauma 57 (2004) 1260-1265
56. Neely K.W., Norton R.L., and Young G.P. The effect of hospital resource unavailability and ambulance diversions on the EMS system. Prehosp Disaster Med 9 (1994) 172-176
57. Redelmeier D.A., Blair P.J., and Collins W.E. No place to unload: a preliminary analysis of the prevalence, risk factors, and consequences of ambulance diversion. Ann Emerg Med 23 (1994) 43-47
58. Schull M.J., Morrison L.J., Vermeulen M., et al. Emergency department gridlock and out-of-hospital delays for cardiac patients. Acad Emerg Med 10 (2003) 709-716
59. Schull M.J., Morrison L.J., Vermeulen M., et al. Emergency department overcrowding and ambulance transport delays for patients with chest pain. CMAJ 168 (2003) 277-283
60. Liu S., Hobgood C., and Brice J.H. Impact of critical bed status on emergency department patient flow and overcrowding. Acad Emerg Med 10 (2003) 382-385
61. Schull M.J., Vermeulen M., Slaughter G., et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med 44 (2004) 577-585
62. Hwang U., Richardson L.D., Sonuyi T.O., et al. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc 54 (2006) 270-275
63. Chen E.H., Mills A.M., Lee B.Y., et al. The impact of a concurrent trauma alert evaluation on time to head computed tomography in patients with suspected stroke. Acad Emerg Med 13 (2006) 349-352
64. Burt C.W., McCaig L.F., and Valverde R.H. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med 47 (2006) 317-326
65. Kyriacou D.N., Ricketts V., Dyne P.L., et al. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med 34 (1999) 326-335
66. Weiss S.J., Ernst A.A., Derlet R., et al. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am J Emerg Med 23 (2005) 288-294
67. Baker D.W., Stevens C.D., and Brook R.H. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA 266 (1991) 1085-1090
68. Rowe B.H., Channan P., Bullard M., et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med 13 (2006) 848-852
69. Bindman A.B., Grumbach K., Keane D., et al. Consequences of queuing for care at a public hospital emergency department. JAMA 266 (1991) 1091-1096
70. Bayley M.D., Schwartz J.S., Shofer F.S., et al. The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Ann Emerg Med 45 (2005) 110-117
71. Krochmal P., and Riley T.A. Increased health care costs associated with ED overcrowding. Am J Emerg Med 12 (1994) 265-266
72. Eckstein M., and Chan L.S. The effect of emergency department crowding on paramedic ambulance availability. Ann Emerg Med 43 (2004) 100-105
73. Rondeau K.V., and Francescutti L.H. Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction. J Healthc Manag 50 (2005) 327-340
74. Bucheli B., and Martina B. Reduced length of stay in medical emergency department patients: a prospective controlled study on emergency physician staffing. Eur J Emerg Med 11 (2004) 29-34
75. Donald K.J., Smith A.N., Doherty S., et al. Effect of an on-site emergency physician in a rural emergency department at night. Rural Remote Health 5 (2005) 380
76. Shaw K.N., and Lavelle J.M. VESAS: a solution to seasonal fluctuations in emergency department census. Ann Emerg Med 32 (1998) 698-702
77. Bazarian J.J., Schneider S.M., Newman V.J., et al. Do admitted patients held in the emergency department impact the throughput of treat-and-release patients?. Acad Emerg Med 3 (1996) 1113-1118
78. Kelen G.D., Scheulen J.J., and Hill P.M. Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion. Acad Emerg Med 8 (2001) 1095-1100
79. Moloney E.D., Bennett K., O'Riordan D., et al. Emergency department census of patients awaiting admission following reorganisation of an admissions process. Emerg Med J 23 (2006) 363-367
80. Ross M.A., Naylor S., Compton S., et al. Maximizing use of the emergency department observation unit: a novel hybrid design. Ann Emerg Med 37 (2001) 267-274
81. McConnell K.J., Richards C.F., Daya M., et al. Effect of increased ICU capacity on emergency department length of stay and ambulance diversion. Ann Emerg Med 45 (2005) 471-478
82. Dunn R. Reduced access block causes shorter emergency department waiting times: an historical control observational study. Emerg Med (Fremantle) 15 (2003) 232-238
83. Miro O., Sanchez M., Espinosa G., et al. Analysis of patient flow in the emergency department and the effect of an extensive reorganisation. Emerg Med J 20 (2003) 143-148
84. Lee-Lewandrowski E., Corboy D., Lewandrowski K., et al. Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center. Impact on test turnaround time and patient emergency department length of stay. Arch Pathol Lab Med 127 (2003) 456-460
85. Washington D.L., Stevens C.D., Shekelle P.G., et al. Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial. Ann Intern Med 137 (2002) 707-714
86. Derlet R.W., Nishio D., Cole L.M., et al. Triage of patients out of the emergency department: three-year experience. Am J Emerg Med 10 (1992) 195-199
87. Diesburg-Stanwood A., Scott J., Oman K., et al. Nonemergent ED patients referred to community resources after medical screening examination: characteristics, medical condition after 72 hours, and use of follow-up services. J Emerg Nurs 30 (2004) 312-317
88. Lagoe R.J., Hunt R.C., Nadle P.A., et al. Utilization and impact of ambulance diversion at the community level. Prehosp Emerg Care 6 (2002) 191-198
89. Scheulen J.J., Li G., and Kelen G.D. Impact of ambulance diversion policies in urban, suburban, and rural areas of Central Maryland. Acad Emerg Med 8 (2001) 36-40
90. Vilke G.M., Brown L., Skogland P., et al. Approach to decreasing emergency department ambulance diversion hours. J Emerg Med 26 (2004) 189-192
91. Patel P.B., Derlet R.W., Vinson D.R., et al. Ambulance diversion reduction: the Sacramento solution. Am J Emerg Med 24 (2006) 206-213
92. Vilke G.M., Castillo E.M., Metz M.A., et al. Community trial to decrease ambulance diversion hours: the San Diego county patient destination trial. Ann Emerg Med 44 (2004) 295-303
93. Sprivulis P., and Gerrard B. Internet-accessible emergency department workload information reduces ambulance diversion. Prehosp Emerg Care 9 (2005) 285-291
94. Shah M.N., Fairbanks R.J., Maddow C.L., et al. Description and evaluation of a pilot physician-directed emergency medical services diversion control program. Acad Emerg Med 13 (2006) 54-60
95. Haines C.J., Lutes R.E., Blaser M., et al. Paramedic initiated non-transport of pediatric patients. Prehosp Emerg Care 10 (2006) 213-219
96. Michelen W., Martinez J., Lee A., et al. Reducing frequent flyer emergency department visits. J Health Care Poor Underserved 17 1 suppl (2006) 59-69
97. Lee K.H., and Davenport L. Can case management interventions reduce the number of emergency department visits by frequent users?. Health Care Manag (Frederick) 25 (2006) 155-159
98. Bernstein S.L., Verghese V., Leung W., et al. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med 10 (2003) 938-942
99. Weiss S.J., Derlet R., Arndahl J., et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med 11 (2004) 38-50
100. Reeder T.J., Burleson D.L., and Garrison H.G. The overcrowded emergency department: a comparison of staff perceptions. Acad Emerg Med 10 (2003) 1059-1064
101. Epstein S.K., and Tian L. Development of an emergency department work score to predict ambulance diversion. Acad Emerg Med 13 (2006) 421-426
102. Weiss S.J., Ernst A.A., and Nick T.G. Comparison of the National Emergency Department Overcrowding Scale and the Emergency Department Work Index for quantifying emergency department crowding. Acad Emerg Med 13 (2006) 513-518
103. Raj K., Baker K., Brierley S., et al. National Emergency Department Overcrowding Study tool is not useful in an Australian emergency department. Emerg Med Australas 18 (2006) 282-288
104. Weiss S.J., Arndahl J., Ernst A.A., et al. Development of a site sampling form for evaluation of ED overcrowding. Med Sci Monit 8 (2002) CR549-CR553
105. Solberg L.I., Asplin B.R., Weinick R.M., et al. Emergency department crowding: consensus development of potential measures. Ann Emerg Med 42 (2003) 824-834
106. Connelly L.G., and Bair A.E. Discrete event simulation of emergency department activity: a platform for system-level operations research. Acad Emerg Med 11 (2004) 1177-1185
107. Chin L., and Fleisher G. Planning model of resource utilization in an academic pediatric emergency department. Pediatr Emerg Care 14 (1998) 4-9
108. Cameron P., Scown P., and Campbell D. Managing access block. Aust Health Rev 25 (2002) 59-68
109. Lagoe R.J., Kohlbrenner J.C., Hall L.D., et al. Reducing ambulance diversion: a multihospital approach. Prehosp Emerg Care 7 (2003) 99-108
110. Schneider S., Zwemer F., Doniger A., et al. Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med 8 (2001) 1044-1050
111. Cardin S., Afilalo M., Lang E., et al. Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions?. Ann Emerg Med 41 (2003) 173-185
112. Salazar A., Corbella X., Sanchez J.L., et al. How to manage the ED crisis when hospital and/or ED capacity is reaching its limits. Report about the implementation of particular interventions during the Christmas crisis. Eur J Emerg Med 9 (2002) 79-80
113. Schull M.J., Kiss A., and Szalai J.P. The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med 49 (2007) 257-264
114. Siddharthan K., Jones W.J., and Johnson J.A. A priority queuing model to reduce waiting times in emergency care. Int J Health Care Qual Assur 9 (1996) 10-16
115. Gross D., and Harris C.M. Fundamentals of Queuing Theory (1985), Wiley, New York, NY