Overcrowding in emergency department: an international issue

Abstract

Overcrowding in the emergency department (ED) has become an increasingly significant worldwide public health problem in the last decade. It is a consequence of simultaneous increasing demand for health care and a deficit in available hospital beds and ED beds, as for example it occurs in mass casualty incidents, but also in other conditions causing a shortage of hospital beds. In Italy in the last 12-15 years, there has been a huge increase in the activity of the ED, and several possible interventions, with specific organizational procedures, have been proposed. In 2004 in the United Kingdom, the rule that 98 % of ED patients should be seen and then admitted or discharged within 4 h of presentation to the ED ('4 h rule') was introduced, and it has been shown to be very effective in decreasing ED crowding, and has led to the development of further acute care clinical indicators. This manuscript represents a synopsis of the lectures on overcrowding problems in the ED of the Third Italian GREAT Network Congress, held in Rome, 15-19 October 2012, and hopefully, they may provide valuable contributions in the understanding of ED crowding solutions.

Overcrowding in the Emergency Department and Patient Safety

“…Emergency department (ED) overcrowding is a recognized problem worldwide [1,2]. Although isolated and not-so-isolated instances of overcrowding likely have occurred for as long as EDs have been in existence, atention was brought to the problem in the United States (US) in the early 1990s, when both the lay press and the research community began to consider the impact of overcrowded EDs on patient care [3].…”

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

“…ED crowding has been a recognized problem in the United States since the mid‐1980s,3, 11 occurs in most developed countries,12, 13, 14, 15 and is described as a “worldwide public health problem.”16 Increased demand for services also results in increased service provision costs. For example, in the United Kingdom demand for ambulance services rises annually by 6.5% and increases costs annually by £60 million ($85 million) 17…”

Emergencies and Disaster Medicine

“…Au début des années 70, des études signalant la charge accrue de travail et l'encombrement des urgences émergent alors comme un sujet important pour la recherche. L'encombrement universel des services des urgences [10] suscite des interrogations: est-il un indicateur de qualité des soins ? D'une vulnérabilité économique et sociale ?…”