Emergency Department Crowding: A Call for Unity

ED crowding is a global issue. It impact on millions of patient every day. Crowding must

be seen as patient safety and quality issue and not just as an operational issue. The

evidence suggests that, while there are many factors contributing to ED crowding,

emergency physicians must adopt a definition that centers on quality. The definition

must include the dimensions adopted by the Institute of Medicine and follow the

guidelines discussed above. Likewise emergency physicians must argue that ED

crowding must rise to the same level of importance as eliminating wrong site surgery,

decreasing hospital acquired infections and the other goals listed in table 1. Emergency

physicians must argue that national and regulatory standards addressing patient be

implemented and adhered to by hospitals. The time has come to accept that the factors

associated with crowding are not within the control of emergency physicians during

their day to day activities. While adding resources to our emergency departments may

be helpful, asking or demanding increased productivity form EPs and ED staff will not

correct this problem. While multi-factorial the reason for ED crowding are not found in

the influx of patients or the internal processes of the ED. The reasons are in the output;

they are found within the processes of the organizations emergency departments

support. Staffing critical care beds, allocating general acute care beds for ED patients

and transporting these patients to those beds are the essential components to solving

this global crisis. ED crowding has been present for over twenty years. The time has

come for a unity of purpose, definition, research, solution and adherence following

established guidelines for the delivery of quality care.