The study finds that in the past decade (1990-1999) emergency departments in California decreased by 12 percent, while the number of emergency department visits at each hospital increased 27 percent to about 25,778 annually.
When selected emergency departments permanently closed, the remaining emergency departments added beds. According to the study, the number of emergency department beds per population increased from 14.5 beds to 15.3 beds per 100,000 population.
“Our study shows that while emergency departments have added beds, the typical emergency department patient is much sicker than a decade ago,” said Susan Lambe, MD, of the University of California at San Francisco, and the study’s lead author.
The study finds over the past decade the number of critically ill visits at each emergency department increased by 59 percent and urgent visits for each emergency department increased by 36 percent. While in 1990 nonurgent patients were the largest group of California emergency department visits, in 1999 urgent patients accounted for the largest group of visits, added Dr. Lambe.
“For years, insurance companies, HMOs and some health policy advisors have said that emergency departments attract and encourage patients with nonurgent problems,” said Robert W. Derlet, MD, of the University of California Davis Medical Center in Sacramento, and author of a related editorial in this issue. “This study clearly indicates a dramatic increase in patients who need emergency care, which leaves little capacity in the emergency department to care for people with less urgent problems.”
In fact, the study shows an 8-percent decline in nonurgent visits to emergency departments and a significant 30-percent decrease in the nonurgent visits per emergency department bed.
The number and use of beds are significant because a lack of empty beds leads to various problems, including emergency departments diverting ambulances to other hospitals because they can’t safely take another acutely ill patient, which has become a nationwide public health problem. Dr. Derlet said critically ill patients occupy emergency department beds longer and require more intensive care so fewer patients are able to move through the system— decreasing an emergency department’s capacity to care for more patients.
“If you pour water into a full glass it simply overflows,” said Dr. Derlet. “In the case of emergency departments, when they are filled with very sick and injured patients, other patients, mostly nonurgent, leave after waiting what may be long periods of time in the waiting rooms.”
Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical organization with nearly 22,000 members, who are specialists in emergency medicine. ACEP is committed to improving the quality of emergency care through continuing education, research and public education.
Note: Embargoed copies of the study and editorial are available from the Washington office of the American College of Emergency Physicians at 202-728-0610 ext.3006
If you are interested in interviewing a local emergency physician who is an expert on emergency department overcrowding in your area; the study author, Dr. Susan Lambe; the editorial author, Dr. Derlet, or Dr. Brent Asplin, please call Colleen Horn or email her at chorn@acep.org.
Journal
Annals of Emergency Medicine