Causes Of ED Overcrowding
Whether a person or their loved-one is suffering from a severe mental illness or a life-threatening ailment, a trip to the emergency room is what comes to mind immediately. Emergency department (ED) provides emergency care to our community twenty-four hours a day, seven days a week, and 365 days per year minus the waiting part. Wait time fluctuates throughout the day, from a few minutes to a few hours until a patient in the waiting area is seen in the triage. Regardless, the ED lives to the expectation of providing emergency care to any patient with acute or chronic sickness and injuries at any time of a given day. On peak times, the emergency department runs its operation above capacity— “a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time” (Sinclair, 2007). When there are more patients than treatment rooms available, ED overcrowding occurs. It does not necessarily mean that the
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root of the problem is strictly isolated inside the emergency department when pinpointing its cause.
A few factors such as lack of rooms for admission, shortage of primary care physicians, staff shortage, etc. are external causes that lead to the congestion of EDs. Scarcity of inpatient beds for
admittance plays a big part in the overcrowding, as patients are occupying rooms that could have been used for another one that really needs it. As for the boarders inside the ED, they are mostly patients on involuntary hold, patients needing placement, or mentally-ill patients waiting for psychiatric unit beds to free up. According to a study done in California by Stone et al., “The average wait time for adult patients with a primary psychiatric diagnosis in the ED, once the decision to admit was made until placement into an inpatient psychiatric bed or transfer to an appropriate level of care, was 10.05 hours” (2010). That amount of time could have been enough for a physician to tend to two or more patient. After the deinstitutionalization movement of psychiatric patients in the 1960s, the amount of inpatient and residential psychiatric beds in the United States significantly dropped. As a result, individuals with mental health problems get less access to any appropriate help they need in the time of their crisis. As stated on Alakeson, Pande, and Ludwig’s (2010) article on the health care journal Health Affairs, overcrowded emergency rooms have become the last resort for psychiatric patients to go into. In addition, a poll conducted by the American College of Emergency Physicians stated that, 48% of the overall physician respondents said mentally-ill patients are housed in the emergency department at least once a day (Physician Poll on Psychiatric Emergencies, October 2016). Unlike other departments of the hospital, the emergency department is not organized for continuing care let alone psychiatric care. Supposedly, the focal function of the ED is to stabilize its patients and then send them accordingly. The smooth flow of stabilize-discharge/transfer/admit process is disrupted when a room is boarded by a mentally-ill patient waiting for appropriate placement or currently in involuntary hold.
Boarding of psychiatric patients is not the leading cause in ED overcrowding. But, it triggers a chain of events that results to more frequent congestion of that particular ED.
root of the problem is strictly isolated inside the emergency department when pinpointing its cause.
A few factors such as lack of rooms for admission, shortage of primary care physicians, staff shortage, etc. are external causes that lead to the congestion of EDs. Scarcity of inpatient beds for
admittance plays a big part in the overcrowding, as patients are occupying rooms that could have been used for another one that really needs it. As for the boarders inside the ED, they are mostly patients on involuntary hold, patients needing placement, or mentally-ill patients waiting for psychiatric unit beds to free up. According to a study done in California by Stone et al., “The average wait time for adult patients with a primary psychiatric diagnosis in the ED, once the decision to admit was made until placement into an inpatient psychiatric bed or transfer to an appropriate level of care, was 10.05 hours” (2010). That amount of time could have been enough for a physician to tend to two or more patient. After the deinstitutionalization movement of psychiatric patients in the 1960s, the amount of inpatient and residential psychiatric beds in the United States significantly dropped. As a result, individuals with mental health problems get less access to any appropriate help they need in the time of their crisis. As stated on Alakeson, Pande, and Ludwig’s (2010) article on the health care journal Health Affairs, overcrowded emergency rooms have become the last resort for psychiatric patients to go into. In addition, a poll conducted by the American College of Emergency Physicians stated that, 48% of the overall physician respondents said mentally-ill patients are housed in the emergency department at least once a day (Physician Poll on Psychiatric Emergencies, October 2016). Unlike other departments of the hospital, the emergency department is not organized for continuing care let alone psychiatric care. Supposedly, the focal function of the ED is to stabilize its patients and then send them accordingly. The smooth flow of stabilize-discharge/transfer/admit process is disrupted when a room is boarded by a mentally-ill patient waiting for appropriate placement or currently in involuntary hold.
Boarding of psychiatric patients is not the leading cause in ED overcrowding. But, it triggers a chain of events that results to more frequent congestion of that particular ED.