CDC reports sharp increase in ED visits

Numbers blamed partly on boarding of patients

New data from the federal Centers for Disease Control and Prevention (CDC) show that the number of ED visits increased by 20% over a 10-year period, from 89.8 million in 1992 to 107.5 million in 2001. Much of the increase can be attributed to the practice of boarding patients in the ED, according to another federal report.

The CDC notes that, over the past decade, the number of EDs decreased by 15%, contributing to increased patient volumes and waiting times at the remaining facilities. Patients spent an average of three hours in the ED, from arrival to discharge, but more than half spent two to six hours. More than 400,000 visits lasted 24 hours or longer.

Much of the pressure on EDs is caused by the practice of boarding patients, in which patients are kept in the ED because no inpatient bed is available, according to a recently report by the General Accounting Office (GAO) in Washington, DC.

That report found that ED overcrowding is most severe in areas with large populations, with nearly one in 10 hospitals diverting ambulances to other hospitals more than 20% of the time. The GAO report confirms what many ED managers have long argued with hospital administrators, says George Moltzen, MD, president of the American College of Emergency Physicians (ACEP).

"It clearly shows that failure to move patients from the emergency department into hospital inpatient beds plays a major role in crowding," he says. "This practice results in patients being boarded in emergency departments who require equipment and staff time, which further shrinks emergency department resources to treat severely injured and sick patients. It also limits a hospital’s ability to meet periodic surges in demand, such as those from disasters."

The GAO report indicates that hospitals in areas with populations of 2.5 million or more reported higher levels of all three crowding indicators identified by the government auditors: ambulance diversion, the percentage of patients boarded in the ED for two hours or more, and the proportion of patients who leave without medical evaluations.

Two-thirds of all EDs diverted ambulances to other hospitals at some point in 2001, and one-third of hospitals reported that three-fourths or more of their patients were boarded for at least two hours in the past year.

Boarding of patients also is cited as a primary reason for ED crowding by Mel Wilson, RN, MS, FNP, CEN, president-elect of the Des Plaines, IL-based Emergency Nurses Association (ENA) and nurse trauma coordinator for New Hanover Regional Medical Center in Wilmington, NC. The latest statistics indicate a growing problem for EDs, she says.

"When emergency departments become overcrowded, the risk of medical errors increases," Wilson says.

"It reduces the time available to care for critically ill patients and forces hospitals to go on diversion, putting other patients at risk of not receiving emergency care when they need it most," she adds.

Sources

For more information, contact:

American College of Emergency Physicians, 1125 Executive Circle, Irving, TX 75038-2522. Telephone: (800) 798-1822.

Mel Wilson, Nurse Trauma Coordinator, Emergency Department, New Hanover Regional Medical Center, 2131 S. 17th St., Wilmington, NC 28401. Telephone: (910) 343-7000.

The Centers for Disease Control and Prevention report is available at www.cdc.gov/nchs/. Click on "National Hospital Ambulatory Medical Care Survey: 2001 Emergency Department Summary."

The General Accounting Office report, Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities, is available at www.gao.gov. Select "more search options," then "GAO Reports," and then enter report number GAO-03-460.