Emergency department (ED) crowding and resultant delays in patient care are not simply matters of patient or staff inconvenience but have been incontrovertibly shown to lead to patient harm. ED crowding is a problem largely caused by overall hospital crowding and thus cannot be solved by a single department but through ongoing commitment by institutional leaders as well as payer and regulatory segments of the health care system. This is an assessment put forward in a commentary article titled Emergency Department Crowding: The Canary in the Health Care System, published in New England Journal of Medicine Catalyst.
The commentary suggests that while ED crowding may be inaccurately considered a problem of ED operations and inefficiency, in truth, ED status is reflective of not just individual department or individual hospital performance, but of health system dysfunction and funding structure flaws throughout the United States.
While the ultimate solution is reform of health care financing that forces inefficiently high inpatient census, the authors of the article provide a comprehensive list of actionable solutions that institutions can implement to alleviate problems associated with ED crowding. It also outlines five essential elements to address the issue: acknowledgement of overcrowding as a serious threat to patient safety, the necessity of support and action from upper-level institutional leadership, financial realignment of reimbursement, regulation by governing agencies to address the impact and potential implications, and the need for enforceable preemptive surge plans to be created and actuated.
"We owe it to our patients and the communities we serve to find solutions to this serious threat to patient safety," said Gail D'Onofrio, MD, MS, Albert E. Kent professor of emergency medicine and chair of emergency medicine, Yale University School of Medicine.
"We have a duty to address a growing danger to the safety of our patients and communities caused by a dysfunctional and inequitable health care system," added Richard E. Wolfe, MD, chief of emergency medicine, Beth Israel Deaconess Medical Center and associate professor of emergency medicine, Harvard Medical School.
The lead author of the study is Gabor D. Kelen, MD, professor of emergency medicine and anesthesiology and critical care medicine at Johns Hopkins University School of Medicine.
The article was coauthored by members of the Association of Academic Chairs of Emergency Medicine (AACEM), an organization of the Society for Academic Emergency Medicine. AACEM works to improve and support academic emergency medicine in the advancement of health care through high-quality education and research. The AACEM mission is to provide guidance to emergency departments, discover and disseminate resources, facilitate leadership, and develop partnerships to advance and advocate for academic emergency medicine.
