Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Healthy You
    • Job listings
    • Q&As
    • Special sections
  • Multimedia
    • Quiz
    • Podcasts
    • Videos
  • FAQs
    • Advertising
    • Subscriptions
    • For APHA members
    • Internships
    • Change of address
  • About
    • About The Nation's Health
    • Submissions
    • Permissions
    • Purchase articles
    • Join APHA
  • Contact us
    • Feedback
  • APHA
    • AJPH
    • NPHW

User menu

  • My alerts

Search

  • Advanced search
The Nation's Health
  • APHA
    • AJPH
    • NPHW
  • My alerts
The Nation's Health

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Healthy You
    • Job listings
    • Q&As
    • Special sections
  • Multimedia
    • Quiz
    • Podcasts
    • Videos
  • FAQs
    • Advertising
    • Subscriptions
    • For APHA members
    • Internships
    • Change of address
  • About
    • About The Nation's Health
    • Submissions
    • Permissions
    • Purchase articles
    • Join APHA
  • Contact us
    • Feedback
  • Follow The Nation's Health on Twitter
  • Follow APHA on Twitter
  • Visit APHA on Facebook
  • Follow APHA on Youtube
  • Follow APHA on Instagram
  • Follow The Nation's Health RSS feeds
NewsWeb-only News

Study: Not enough hospitals addressing ER overcrowding

Kim Krisberg
The Nation's Health March 2016, 46 (2) E6;
Kim Krisberg
  • Search for this author on this site

Even though emergency department overcrowding is associated with worse patient care and mortality rates, many of the nation’s hospitals have yet to implement proven interventions, researchers report.

In a study published in the December issue of Health Affairs, researchers found that overcrowded emergency departments adopted a greater number of interventions than less-crowded emergency departments. However, even among the most crowded emergency departments, a large number had not adopted proven intervention strategies, such as bedside registration and surgical schedule smoothing, which plans surgeries according to inpatient bed availability. On the upside, the average number of emergency department overcrowding interventions used by hospitals increased 25 percent between 2007 and 2010, from 5.2 to 6.6.

According to the study, emergency department crowding is a continuing problem in the U.S. and is associated with higher mortality rates, higher rates of cardiovascular complications among patients with chest pains and poorer patient experiences. Solutions that can be used to address overcrowding include interventions at both the hospital and emergency department levels, from implementing tracking systems to diverting ambulances.

“The first thing to realize when it comes to emergency room crowding is it’s a complex and multifactorial problem that involves many different stakeholders and many simultaneously interacting factors, so it’s not a simple problem,” said study co-author Jesse Pines, MD, MBA, director of the Office for Clinical Practice Innovation and a professor of emergency medicine and health policy at George Washington University School of Medicine and Health Sciences. “But from someone who works in an emergency department, I think this is a huge problem.”

To conduct the study, Pines and his research colleagues examined 2007-2010 data from the National Hospital Ambulatory Medical Care Survey, classifying each of the 17 overcrowding interventions studied as either a hospital-level intervention or an emergency department-level intervention. The final study sample included about 340 hospitals per year and a total of about 139,500 patient encounters, which represented a nationwide average of 127 million emergency department visits every year. Researchers found a significant increase in the average number of hospital-level interventions, from 2.2 in 2007 to three in 2010, but a nonsignficant increase in emergency department-level interventions, from three to 3.5.

The intervention that gained the most steam during the study period was full-capacity protocol, which moves admitted patients from the emergency department to inpatient units. Use of that intervention grew from 21 percent of hospitals in 2007 to more than 45 percent in 2010. Many more hospitals — an increase from about 10 percent to more than 20 percent — also instituted radio-frequency identification tracking, which allows a patient’s location to be tracked throughout the emergency department.

Researchers observed smaller increases among interventions that were already common in 2007, such as bedside registration and bed census availability. The one intervention that declined during the study period — from nearly 36 percent of hospitals studied to about 21 percent — was the presence of an emergency department observation unit, which extends observation times for patients who do not require admission in an effort to reduce short hospital stays. Still, a large proportion of the most crowded hospitals did not adopt proven interventions. For instance, 19 percent of the most crowded emergency departments had not adopted bedside registration and 94 percent had not adopted surgical schedule smoothing, the study found. Overall, researchers found that teaching hospitals were most likely to adopt crowding interventions.

“Hospitals have been slow to adopt interventions that require a change in hospital-wide protocols,” the study stated. “This may reflect the fact that (emergency department) crowding is a low hospital-wide priority in many facilities, despite the fact that it continues to worsen.”

Pines told The Nation’s Health that while crowding is now a national quality measure in health care delivery and included in accreditation standards that address patient flow, “there aren’t really teeth in either of those recommendations.” He predicted that at least in the short term, emergency department crowding will continue as more people become insured and seek out health services. However, he noted that the growth of retail clinics, urgent care clinics and freestanding emergency rooms could impact hospital crowding in the long term, as could changes in federal reimbursement rates that consider crowding measures as part of value-based purchasing.

“Unless it becomes a hair-on-fire issue for hospitals, we’ll continue to see slow adoption of interventions,” Pines said. “But the literature is clear that it’s more dangerous for patients to come in during crowded times. So from a public health perspective, reducing crowding needs to be a major priority.”

For more information, visit http://content.healthaffairs.org/content/34/12/2151.abstract.

  • Copyright The Nation’s Health, American Public Health Association
PreviousNext
Back to top

In this issue

The Nation's Health: 46 (2)
The Nation's Health
Vol. 46, Issue 2
March 2016
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)

Healthy You

Healthy You

Print
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article
We do not capture any email addresses.
Enter multiple addresses on separate lines or separate them with commas.
Study: Not enough hospitals addressing ER overcrowding
(Your Name) has sent you a message from The Nation's Health
(Your Name) thought you would like to see this item on The Nation's Health website.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Study: Not enough hospitals addressing ER overcrowding
Kim Krisberg
The Nation's Health March 2016, 46 (2) E6;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Study: Not enough hospitals addressing ER overcrowding
Kim Krisberg
The Nation's Health March 2016, 46 (2) E6;
del.icio.us logo Twitter logo Facebook logo Mendeley logo
Tweet Widget Facebook Like LinkedIn logo

Jump to section

  • Top

More in this TOC Section

  • Newsmakers: May 2025
  • Newsmakers: April 2015
  • Newsmakers: February/March 2025
Show more Web-only News

Subjects

  • Medical Care

Popular features

  • Healthy You
  • Special sections
  • Q&As
  • Quiz
  • Podcasts

FAQs

  • Advertising
  • Subscriptions
  • For APHA members
  • Submissions
  • Change of address

APHA

  • Join APHA
  • Annual Meeting
  • NPHW
  • AJPH
  • Get Ready
  • Contact APHA
  • Privacy policy

© 2025 The Nation's Health

Powered by HighWire