CDC: Almost Half of Hospitals Experience Crowded Emergency Departments

This also in: water is wet.  Really, I’m surprised it’s only reported as half.

The CDC Report from the National Center for Health Statistics was released today:

Staffing, Capacity, and Ambulance Diversion in Emergency Departments: United States, 2003-04. Advance Data 376. 24 pp. (PHS) 2006-1250. Click to open PDF file 1.1 MB

I like some of their bullets, so I’ll stick them in here:

bullet graphicAn average of 4,500 EDs were in operation in the United States during 2003 and 2004.

bullet graphicCrowding in metropolitan EDs was associated with a higher percentage of nursing vacancies, higher patient volume, and longer patient waiting and treatment durations.

bullet graphicHalf of EDs in metropolitan areas had more than 5 percent of their nursing positions vacant.

bullet graphicApproximately one-third of U.S. hospitals reported having to divert an ambulance to another emergency department due to overcrowding or staffing shortages at their ED.

The thing I wanted to know is their definition of ‘crowded’, which isn’t on the summary page, but is on page 5:

Crowding in the ED is a result of demand exceeding capacity.  Although crowding is often measured as an opinion of ED staff or recently measured as full waiting rooms (23,24), NHAMCS did not collect these data elements. To estimate the number of hospitals experiencing ED crowding, responses to the SCAD and BT supplements and estimates of throughput from the NHAMCS visit data for each hospital were used.  Therefore, in this report, the measure of whether the ED experienced crowded conditions was obtained using the following criteria: having any ambulance diversion hours reported, having a mean waiting time for urgent cases greater than 60 minutes, or having the percentage of cases left without being seen greater than or equal to 3 percent.

(emphasis added)

That’s an okay measure, I suppose, though we could have quibbles with any of those definitions (hopefully they’re fixing their survey tool to ask for actual bodies-in-beds percentages rather than these surrogate markers).


Take-home message?  If yo go to any ED, be prepared to wait.  And hope you don’t have a hand injury.

Update: I posted the above, then my New England Journal Title page arrived, and It’s Official: Crisis in the Emergency Department.

It’s a good summary editorial of the recent IOM findings, and has a nice graph (NEJM knows how to make a pretty graph): 

Figure 1


Read the editorial and it’s pretty good, but here’s the paragraph that made me think there might be a breakthrough:

Economic forces underlie these trends. When Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) in 1986, everyone in the United States acquired a legal right to emergency care. But no funding was provided to pay for it. Not only did this unfunded mandate contribute to the closure of numerous emergency departments and trauma centers, it also created a perverse incentive for hospitals to tolerate emergency department crowding and divert ambulances while continuing to accept elective admissions. Rather than improving access to emergency care, EMTALA diminished it. (my emphasis)

So, then recommendations are made, and they’re pretty good: streamline and consolidate a lot of bureaucracy, stop boarding patients in the ED, regionalize EMS and trauma decisionmaking, etc.

What’s not mentioned?  EMTALA.  He correctly identified it as a major problem then promptly ignored it in the conclusions.  It should either be paid for (it’s THE unfunded mandate that’s killing our ED’s), or scrapped. 


  1. Awesome post. The only aspect of my job that I hate is the constant complaints about the waiting times. “This is ridiculous! Y’all need to hire more doctors!”

    If only it were so simple.

  2. This is ridiculous! Y’all need to hire more doctors

    Heh… I love that one. My response?

    “Yeah… I know. If more people had actual insurance or paid their medical bills, we could probably afford more”

    Since roughly half of my patients are self-pay or some kind of ‘caid (and even the insured ones figure that out after a few hours in the waiting room), that usually ends that conversation…

  3. You have reported this fairly. Emergency services, and emergency departments in particular, provide the backbone for our medical communities – indeed, for our communities. It is essential that our profession do everything within reason to continue to point that out to government and funding agencies at every level.