Hospital overcrowding is a serious, persistent problem that can put patient safety at risk. It also puts the hospital at a disadvantage in the marketplace, as patients may seek care elsewhere.
Overcrowding in hospitals leads to decreased quality of care, delayed treatment of seriously ill patients, increased costs (as patients spend more time in the ED), and lower patient satisfaction rates. It is a worldwide concern with some estimates of ED overcrowding in up to 50% of hospitals.
A recent NEJM Catalyst article identified essential steps to mitigate overcrowding in the emergency department, including recognizing it as a problem and a threat to patient safety; encouraging visible, committed leadership buy-in; and focusing improvement efforts on the entire hospital, not just the ED.1
One of the most common causes of overcrowding is a shortage of available inpatient beds. Patients that require an ICU or step-down bed are often admitted to the ED and must board until such a bed becomes available. This can lead to prolonged ED LOS and increased staffing demands on the nursing team.
Several studies have shown that mortality rates for patients who present during a period of ED overcrowding are higher than in non-crowded periods. Moreover, these patients are more likely to experience complications such as cardiac arrest, recurrent myocardial infarction, or hypotension. The ED boarding situation has been exacerbated by the shift away from scheduled surgery to the ambulatory setting, which has resulted in a large number of unscheduled admissions that must go through the ED.