POSITION STATEMENT overcrowding

Hospital and Emergency Department Overcrowding

[This position statement was developed by the ACEP Task Force on Hospi- tal and Emergency Department Overcrowding and the Emergency Nurses Association, and was approved by the Board of Directors on September 8, 1989. American College of Emergency Physicians: Hospital and emergency department overcrowding. Ann Emerg Med March 1990;19:336.]

Many Americans face a crisis in health care that is widespread and grow- ing. Hospital overcrowding, and the resultant congestion and holding of patients that occurs in emergency departments in many parts of the coun- try, is severely limiting the public's right to t imely access to emergency medical care and the quality of that care.

There are numerous factors contributing to the problem of emergency department overload, including a shortage of health care professionals, especially nurses; increased numbers of poor and/or uninsured patients; and hospital or emergency department closures. Underlying many of these factors is inadequate funding for health care services during a period of increasing demand. The emergency department is generally the first area compromised when hospitals do not have an adequate number of beds for patients requiring hospital admission, because such patients remain in the emergency department.

Therefore, emergency physicians and nurses are called on to provide on- going inpatient and intensive care (ICU} services in the emergency depart- ment, in addition to their responsibilities to other emergency patients. Thus, their capacity to provide safe and efficient medical and nursing care is, at best, limited. With increasing frequency, the overburdened resources of crowded emergency departments have forced staff to delay basic emer- gency care to sick and injured individuals. In some areas, the health care system has become so overcrowded that there are prolonged delays for pre- hospital providers to find available emergency departments for ambulance patients. These delays further decrease the availability of emergency medi- cal services vehicles and manpower, and therefore lengthen emergency medical services response times. In the interest of every citizen of this nation, this trend cannot be allowed to continue.

Emergency physicians and nurses cannot by themselves control the fac- tors that impair the availability, timeliness, and quality of the emergency care they provide. While they are worldng with their colleagues to improve the efficiency of hospital admission and discharge procedures, to facilitate communication between hospitals and prehospital providers regarding hos- pital and emergency department bed availability, and to standardize poli- cies that regulate regional emergency department availability and ambu- lance diversions, these are only stopgap measures; long-term solutions are urgently needed.

On behalf of our patients, the American College of Emergency Physi- cians and the Emergency Nurses Association challenge other health care organizations, allied agencies, lawmakers, and concerned groups or individ- uals to join in examining both short- and long-term solutions to this prob- lem at both the local and national level, developing recommendations and, most importantly, educating the public regarding the nature and impor- tance of this issue.

ACEP and ENA remain committed to timely access by emergency de- partment patients to necessary emergency and inpatient hospital care.

American College of Emergency Physicians Dallas, Texas

Address for reprints: American College of Emergency Physicians, PO Box 619911, Dallas, Texas 75261-9911.

19:3 March 1990 Annals of Emergency Medicine 336/179