A Prescription for ER Overcrowding

Reducing the volume of walk-in patients with minor illnesses will not alleviate the problem of overcrowded emergency departments, says Dr. Michael Schull, an assistant professor of emergency medicine at U of T.

Schull and colleagues conducted a study that measured overcrowding in the emergency unit at Sunnybrook and Women’s College Health Sciences Centre in Toronto. They examined how often the unit diverted ambulances to other hospitals, the volume of patients, staffing levels and delays in assessment. Although 84 per cent of patients were walk-in cases with minor illnesses, the researchers found they had little impact on overcrowding because staff dealt with these cases efficiently without compromising care for more seriously ill patients.

Indeed, the greatest strain came from the most acutely ill patients. When beds and stretchers in the emergency department are occupied by people waiting a long time for tests, decisions or a hospital bed, the department becomes overcrowded and slow to accept new patients, according to the study, published in the Annals of Emergency Medicine. “This suggests that if we’re going to solve the problem of overcrowding, then we have to increase a hospital’s capacity to quickly assess and admit the patients who are the most acutely ill,” says Schull. “But this is about more than just opening more hospital beds. It means better access to diagnostic services, enhancing alternatives to admission such as home care, better management of chronic disease in the community to reduce exacerbations, and better prevention through things such as the influenza vaccination.”