What are the causes and consequences of ED overcrowding? Inability to move admitted patients from the ED to appropriate inpatient units – Hospital occupancy is positively associated with patient waiting time in the ED and hours spent on ambulance diversion – Lack of staffed inpatient beds, scarcity of beds in ICU – Lack of beds is the most common cause for ambulance diversion – 56.4% of total diversion hours

What are the causes and consequences of ED overcrowding? Lack of key clinical staff – Hospitals with greatest time on ambulance diversion also had highest rate of vacant positions for registered nurses – Growing shortage of specialist physicians willing to work on-call in the ED – Difficult on-call coverage – uncompensated care, marketwide shortage of specialists, lifestyle preferences and fear of medical liability

What are the causes and consequences of ED overcrowding? Care provided to the uninsured and non- urgent conditions is NOT a driver to ED overcrowding – Waiting times for severely ill patients in the ED are generally not affected by high volumes of low severity patients

What are the causes and consequences of ED overcrowding? Growth in Psychiatric ED visits is a contributor to ED Overcrowding – no association? – Created new challenges for ED staff and signals emerging shortages of mental health care – Psychiatric patients are time consuming, difficult to care for and disturbing to other patients – More difficult to find inpatient beds – Growth in the demand for psychiatric care in the ED has coincided with reductions in mental health funding and capacity, especially for low income populations

What are the causes and consequences of ED overcrowding? Reduced access in the form of longer waiting times for care, patients leaving the ED without being seen and disruptions to ambulance service – A hospital goes on ambulance diversion about once every minute – Ambulance diversion increases ambulance transport time by anaverage of 1.7 to 5 minutes – Ambulances may also be taken out of service when paramedics are waiting for an open gurney

What are the causes and consequences of ED overcrowding? Reduced Health Care Quality and Patient safety – Delay or failure to receive needed antibiotics and analgesic medications in the ED – Patient mortality increases when hospitals experience ED overcrowding – Adverse events are more likely to occur when hospital occupancy approaches 100%

What are the causes and consequences of ED overcrowding? More effective to use existing capacity more efficiently – Adding new capacity to an inefficient system may just create larger facilities that remain overcrowded – Improve efficiency of internal processes : flow of patients across units – Sustained commitment to improving workflow and efficiency throughout the entire hospital rather than the ED by itself

What are the cost implications of ED utilization? True costs associated with care in the ED, particularly non-urgent care, are not well understood – Lack of patient records and the practice of screening for emergencies lead to more expensive testing and other procedures – Varies significantly by type of hospital