Emergency Department Crowding Portends a Worrying Trend


 Emergency Department Staff Although emergency department (ED) visits increased 140% over eight years, medical imaging had a smaller net effect on overcrowding than other diagnostic tests and clinical procedures, according to research published in the July 2012 issue of Annals of Emergency Medicine, and reported by Cardiovascular Business. Stephen Pitts, M.D., MPH, of the department of emergency medicine at Emory University in Atlanta, and colleagues evaluated trends in ED crowding and potential causes by analyzing trends in ED occupancy.

While the results showed that imaging tests were less prevalent than other diagnostics, the researchers warned hospitals that their results have ominous implications for patient safety.


  • higher rates of medical errors
  • more frequent complications
  • increased mortality rates among critically ill patients

Longer ED Visits Don’t Tell Whole Story

One possible positive outcome they noted is that longer ED stays are less costly than preventable hospitalizations.

Dr. Pitts and colleagues offered some possible causes for their findings. They suggested that increasing treatment intensity may be tied to the aging population that arrives with complex medical issues. A push for higher quality care may reflect an increasingly interventionist practice style and financial incentives for higher intensity care or defensive medicine may explain the reason for more tests and procedures. (Source: HealthImaging)

Insurance Coverage & Emergency Care Cause ER Crowding

A recent survey from the American College of Emergency Physicians (ACEP) supports the “aging population” theory and also points to a worrying trend – emergency rooms are increasingly populated by people who are insured but cannot find a doctor to accept their Medicaid coverage and treat them. A full 97 percent of ER doctors who responded to the ACEP survey said they treated patients daily who fit this profile.

Even patients who have private insurance were sent to the ER because the patient’s need for care arose during a time when that private doctor’s office was closed.

“The results are significant,” said ACEP President Sandra Schneider. “… visits to emergency rooms are going to increase across the country, despite the advent of health care reform, and that health insurance coverage does not guarantee access to medical care.” (Source: NPR)

Although medical imaging hasn’t been responsible for emergency department overcrowding, the news isn’t all good. An abundance of other diagnostic tests and clinical procedures are running up the tab. The rise of elderly in ED may be inevitable. Healthcare organizations will have to find ways to adapt to what is likely the new normal.

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