Dr. Barry Gustin - Medical-Legal Expert Services

Emergency Room Overcrowding and the Dangers: From the perspective of an Emergency Medicine Expert

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Emergency room overcrowding and the dangers related to it have become a central focus of testifying emergency medicine expert witnesses.  The Centers for Disease Control and Prevention (CDC) recently released a report entitled Estimates of Emergency Department Capacity: United States, 2007. This report is based on data from the CDC's 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Inaugurated in 1992, the NHAMCS is now the longest continuously running national survey of hospital ED use.

The report notes that over the last several decades, the role of the ED has expanded from primarily treating seriously ill and injured patients. The report recognizes that EDs now also provide urgent and unscheduled care to patients unable to access their providers in a timely fashion and provide primary care to Medicaid beneficiaries and uninsured patients. As a result, EDs are frequently overcrowded with the most common contributing factor being the inability to transfer ED patients to an inpatient bed once the decision is made to admit them. "As the ED begins to 'board' patients, the space, the staff, and the resources available to treat new patients are further reduced," the report states. It continues, "A consequence of overcrowded EDs is ambulance diversion, in which EDs close their doors to incoming ambulances. The resulting treatment delay can be catastrophic for the patient."

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