Emergency Department Overcrowding and Ambulance Diversion

1
Emergency Department Overcrowding and Ambulance
Diversion

• Robin M. Weinick, Ph.D.
• Director, Intramural Research
• Center for Primary Care Research
• Agency for Healthcare Research and Quality

2
What Is ED Overcrowding?

• Need for emergency services outstrips available
  resources
• More patients than staffed ED beds, long wait
  times
• Patients typically treated and monitored in
  hallways
• Constrains ability to triage patients

3
Measuring Overcrowding

• No established way to measure
• AHRQ is developing a set of measures
• Time from arrival to physician contact
• Number of patients being boarded
• Boarding time
• Time on ambulance diversion

4
Ambulance Diversion

• Closed to ambulance traffic
• A symptom, not the primary problem
• Results in
• Increased ambulance cycle/response time
• More first-time patients
• Forced override
• Measured by number of hours on divert

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Percent of Hospitals At or Over Capacity
Source The Lewin Group Analysis of AHA ED and
Hospital Capacity Survey, 2002
Source The Lewin Group Analysis of AHA ED and
Hospital Capacity Survey, 2002
6
Percent of Hospitals At or Over Capacity
II 79
Bed size
Trauma level
Source The Lewin Group Analysis of AHA ED and
Hospital Capacity Survey, 2002
7
Time on Diversion
8
Factors Leading to Overcrowding

• Increased demand
• Reduced supply
• Staffing shortages

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How Many ED Visits? 1992-2000
Source National Center for Health Statistics,
National Hospital Ambulatory Medical Care
Survey, 1992-2000
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How Many Hospital Beds? 1992-2000
16 decrease
8 decrease
4,547 EDs
4,177 EDs
Source American Hospital Association, Hospital
Statistics
11
How Are Hospitals Staffed?
Total number of new RN graduates
26 decrease
Source Health Resources and Services
Administration, Projected Supply, Demand, and
Shortages of Registered Nurses 2000-2020
12
Emergency Medical Treatment and Active Labor Act
of 1986 (EMTALA)
ED
Home is the place where, when you have to go
there, they have to take you in.
Robert Frost The Death of
the Hired Man,1915