Crowding In Hospital Emergency Departments Continues To Occur

Emergency department crowding continues to occur in hospital emergency departments, and some patients wait longer than the recommended time frames, according to a recent study by the Government Accountability Office (GAO). The GAO reviewed information on (1) ambulance diversion, (2) wait times, and (3) patient boarding. National data showed that (1) about one-fourth of hospitals reported going on ambulance diversion at least once in 2006 and (2) wait times in the emergency departments increased, and in some cases exceeded recommended time frames. Although the officials interviewed and articles reviewed by the GAO noted that the boarding of patients in the emergency department who are awaiting transfer to an inpatient bed or another facility continues to be a problem, national data on the extent to which this occurs is limited. Some of the articles reviewed by the GAO discussed strategies to address crowding, but these strategies have not been assessed on a state or national level.

The GAO analyzed 2006 data from HHS National Center for Health Statistics on the average wait time to see a physician in an emergency department and the percentage of visits in which the wait time exceeded the recommended time frames based on following patient acuity levels:

• Immediate: The average wait time was 28 minutes, with 73.9 percent of patients waiting longer than the one minute recommended time frame;
• Emergent: The average wait time was 37 minutes, with 50.4 percent of patients waiting longer than the maximum 14 minute recommended time frame;
• Urgent: The average wait time was 50 minutes, with 20.7 percent of patients waiting longer than the maximum 60 minute recommended time frame;
• Semi-Urgent: The average wait time was 68 minutes, with 13.3 percent of patients waiting longer than the maximum two hour recommended time frame; and
• Nonurgent: The average wait time was 76 minutes, with no emergency departments in 2006 reporting visits with wait times in excess of the maximum 24 hours.

Articles reviewed and individual subject-matter experts interviewed by GAO reported that a lack of access to inpatient beds continues to be the main factor contributing to emergency department crowding. Additional factors contributing to emergency department crowding may include patients; lack of access to primary care services or a shortage of available on-call specialists.  See GAO Report, GAO-09-347, April 30, 2009.