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New data examines reasons for overcrowded ERs

07.26.2012

Numerous research institutions have looked into the causes and consequences of overcrowded emergency rooms in the U.S., and have uncovered multiple contributing factors.

In May, the Centers for Disease Control and Prevention (CDC) published a study conducted during a six-month period in 2011. Interviewing emergency room patients, the CDC found that 54.5 percent checked in because their doctor's office was closed. Furthermore, 46.3 percent said they went to the ER because there was "no other place to go." The prevalence of urgent care facilities or immediate care clinics in the surrounding areas was not explicitly factored into the survey

Meanwhile, a study from the Annals of Emergency Medicine (AEM) states that the number of total ER trips per year in the U.S. leaped from 107.5 million in 2001 to 123.8 million seven years later. The duration of patients' stays in ERs also rose 30 percent. More unexpected and troubling is the fact that the number of seriously ill cases expanded by almost 25 percent, while patients with less dire ailments only increased by 6 percent. What's more, 69 percent more ER goers required injections of intravenous fluids and 44 percent more needed a blood test.

The AEM researchers chalked up the slower service to increased use of more comprehensive diagnostic methods. Applications of CAT scans, MRIs, and ultrasound increased almost 50 percent from 2001 to 2008.

"The growth of crowding since 2001 has been mostly due to increased practice intensity. If you walked around from room to room at your neighborhood ER and asked people what they were waiting for, almost without fail, they'll say they're there waiting for test results," Stephen R. Pitts, associate professor at Atlanta's Emory University School of Medicine, told American Medical News.

None of this information bodes well for doctors or patients. A 2009 study from the National Institute of Health established a correlation between ER overcrowding and patient deaths and patients fleeing the ER out of frustration, either against doctor's orders or before they could be seen. It also increases the odds of a doctor not acting on his or her better judgement.

"This has to do with cognitive load. [Physicians] might be expected to manage 30 patients at once. During crowded times, that's certainly higher," Dr. Jesse Pines, who co-wrote the AEM study, told American Medical News.

"At a certain point, you can't remember everything," he said.

Categories: Emergency medicine Patient Safety