Understanding Emergency Room Overcrowding with Dr Zulfikar Bux

Jan 24, 2015 News

Emergency rooms function as a public “safety net,” providing care to patients who have unexpected illness or injury that may result in death, disability, or severe pain if not cared for immediately. Unfortunately, emergency rooms worldwide are now being faced with the ever-increasing challenge of overcrowding.
Overcrowding in an emergency room (ER) occurs when there is an extreme volume of patients in ER treatment areas, forcing the ER to operate beyond its capacity. This puts an added level of workload and responsibility on ER staff that is now expected to work beyond their usual level of capacity.
HOW DOES OVERCROWDING OCCUR?
This phenomenon is a reflection of the capacity of the hospitals since overcrowding in the emergency rooms means that bed capacities of the hospitals

Dr. Zulfikar Bux

have been maximized. As a result, admitted patients are kept in the ER until space becomes available on wards. The ER staff is expected to continue to provide care for incoming patients and the bedded admitted patients. The main cause of overcrowding is the increase in patient presentations to a particular hospital. Every hospital has a capacity limit and when this is over-utilized, overcrowding will occur. Patients tend to seek care at ER where they feel care is best. Their condition may not be a medical emergency, but in their minds it is and it warrants care at an ER of their choice. There is a new trend to “go to the ER once you are sick”. It is not always warranted since ERs are designed for true medical emergencies. Outpatient medical centres are designed for non-urgent medical care but are often not utilized to their maximum.
WHAT HAPPENS TO THE PATIENTS?
It’s very unfortunate that patients have to be exposed to the overcrowding in ERs. They may be admitted for days in an ER awaiting care but will receive their medical treatment in the interim. Since the ER is crowded with admitted patients, the incoming patients may face delay in care while the ER staff rearranges resources to accommodate their needs. The BBC health report on January 23 2015 highlights the effect of overcrowding on patient times in the UK. Although they have managed to decrease patient waiting times to 4 hours in the UK, they have still not achieved their target because of the overcrowding.
ARE THERE SOLUTIONS FOR THE OVERCROWDING?
The obvious solution that may come to mind is to continue to build more hospitals. The reality is that it is not the most resource efficient solution.
Studies have found that solutions such as activating a full capacity/surge plan for overcrowding, educating the public about hospital utilization, triaging patients to appropriate centres and providing care to only emergencies, expanding the hospital and ER capacity, improving primary health care which will decrease the disease burden and implementing early discharge plan for patients, can help to minimize overcrowding in the ER.
These are solutions that need multidisciplinary support before they can be implemented and may need modification to suit the individual needs of the respective institution.
THANK YOU TO THE GPHC ACCIDENT & EMERGENCY STAFF
Similar to what is occurring worldwide, The Accident & Emergency Department of the Georgetown Public Hospital Corporation (GPHC A&E) is faced with the daily challenge of overcrowding. The staffers of this emergency room work tirelessly and often go beyond their means to ensure that medical care is delivered to each patient that is in the ER. They are not perfect, but then again none of us are. What makes me proud of them is their ability to save all the lives they have saved and their will to keep trying to improve on their imperfections. I thank each and every team member of the GPHC A&E and wish to remind them “what you do matters, and what matters is what you should always do.

(Dr Zulfikar Bux is an Assistant Professor of Emergency Medicine at the Vanderbilt University and Medical Center and holds the position of Head of the Georgetown Public Hospital’s Accident and Emergency Department.)