Emergency Department Crowding: The Nature of the Problem and Why It Matters

The current state of the American healthcare system has focused national attention on the core issues of patient satisfaction, patient safety, and patient flow. Acute-care settings are often plagued with waits, delays, and dissatisfaction. Nowhere is this more observable and the impact more palpable than in hospital emergency departments (EDs). The profession, the public, and the press have highlighted this area as an important healthcare system concern. There is a disparity between the high level of interest in the core issues, an appreciation of the true nature of the problem, and the ability to effectively implement the solutions. Even in the hospitals and emergency departments where the required knowledge and competencies are available, the ability to effectively integrate them into a functioning and effective improvement program may not exist. Emergency departments are complex operational micro-systems. This chapter outlines and defines key challenges, opportunities, and solutions surrounding emergency department crowding. It also provides a wide-ranging overview of the key drivers behind emergency department crowding and the opportunities for improvement, including important safety, service, and workforce implications. Clinical, volume, workforce, and system issues all play a role in solving crowding.