Overcrowding in the Emergency Department and Patient Safety

Abstract

Emergency department (ED) overcrowding is a recognized problem worldwide. This chapter reviews the scope of the problem, manifestations, repercussions, and potential solutions to this problem. Keywords: emergency department overcrowding, emergency department safety, emergency department systems, emergency department patient care, emergency department throughput, emergency department output 1. Case vignette A 68-year-old man presented to the emergency department (ED) with abdominal pain. The pain was fairly abrupt in onset, constant and severe, with accompanying nausea. He had come in not long after it started, on a busy Monday afternoon during flu season. He sat in a chair in the waiting room while his wife waited 15 min to register him at the line at the window. After 30 min, he underwent triage, during which the nurse noted that the patient appeared more comfortable than he stated he was. He was afebrile with an adequate blood pressure, and had a heart rate of 105. She did not count out a respiratory rate in the interest of time, as she still had eight patients to triage and needed to do repeat vital signs on another 10 who had been waiting for over 2 h. The patient was made an emergency severity index score (ESI) of 3, and put back in the waiting room. After 120 min in the waiting room, the patient was brought back into the ED. He was noted by his ED nurse to have a heart rate of 115 with irregular rhythm. He also took note of a respiratory rate of 26 and a blood pressure of 98/56 mmHg. He called for a physician to evaluate the patient immediately. The physician recognized that the patient had severe abdominal pain in the setting of new atrial fibrillation and was concerned for the possibility of ischemic bowel. She