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Busiest EDs Lag Behind in Instituting Crowding Solutions

WASHINGTON, DC – Here’s some news that likely will come as little surprise to emergency physicians: The most crowded emergency departments in the United States have lagged behind in adopting proven interventions to address backup.

That’s according to a study, published recently in Health Affairs, which evaluated crowding in U.S. hospitals from 2007-10. It found that while the situation has improved somewhat, effective interventions have yet to be adopted by many of the nation's most crowded EDs.

"Emergency department crowding is clearly linked to worse patient care and worse outcomes, including higher mortality rates, higher rates of complications, and errors," said co-author Jesse M. Pines, MD, MBA, of the George Washington University (GW) School of Medicine and Health Sciences. "Patients also, no surprise, have a poorer patient experience. People want fast and effective care, and many of our nation's most crowded emergency departments have not addressed this problem despite the wide availability of proven interventions."

According to the study, the average number of interventions adopted increased from 5.2% to 6.6% over four years. In general, results indicate, more crowded EDs adopted greater numbers of interventions than less crowded EDs. Yet, 19% of the most crowded EDs did not use bedside registration, and 94% did not use surgical schedule smoothing, which helps plan surgical schedules to match inpatient bed availability.

"This data implies that emergency department crowding is still a low priority in many hospitals, despite the fact that it has continued to worsen over the last two decades," added lead author Leah S. Honigman Warner, MD, MPH. "With implementation of the Affordable Care Act and pressure to reduce health care costs, crowding will likely continue to worsen. We know there are effective interventions that can mitigate crowding, now is the time to develop best practices to reduce emergency department crowding so that we can provide the highest-quality patient care."