Emergency Department Position Statement

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EMERGENCY NURSES ASSOCIATION POSITION STATEMENT CROWDING IN THE EMERGENCY DEPARTMENT STATEMENT OF PROBLEM Crowding in our nation’s emergency departments is of increasing concern to health care professionals and health care consumers alike. Although the issue of emergency department (ED) crowding in the United States has appeared in the emergency health care literature since the early 1990s, it has received greater coverage during the last few years, capturing the attention of many Americans and policymakers.1-4 ED crowding can be described as “a situation in which the identified need for emergency services outstrips available resources in the emergency department. This situation occurs in hospital emergency departments when there are more patients than staffed ED treatment beds and wait times exceed a reasonable period.”5 When crowding occurs, patients are often placed in hallways and other non- treatment areas to be monitored until ED treatment beds or staffed hospital inpatient beds become available.6 In addition, crowding may contribute to an inability to triage and treat patients in a timely manner as well as increased rates of patients leaving the emergency department without being seen.4,6 As a result of crowding, hospitals often implement ambulance diversion measures, which means ambulances that would otherwise bring patients to the facility’s emergency department are directed to nearby emergency departments instead.4 In many cases, ambulance diversion may be an ineffective response to crowding.5-9 For example, when one hospital goes on diversion, other area hospitals may begin diverting ambulances as well, potentially resulting in ED crowding throughout the community.8,9 In response to growing national concern over ED crowding, the U.S. General Accounting Office (GAO) conducted a study of hospital emergency departments in metropolitan

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