Emergency department overcrowding: a national crisis.

These seem like typical patients in the intensive care units and medical units of our hospitals. Unfortunately, it is just as likely that they may never have reached those units but instead are still in the emergency department, where they have had to remain since the time of their hospital admission. Overcrowding of our nation’s emergency departments, an intermittent, geographically isolated phenomenon in the 1980s, has reemerged as a widespread, chronic, and debilitating situation today. Overcrowding has a negative impact on patient care, on the missions of an academic medical center, and on the health of a community. Emergency department overcrowding is hard to define but easy to recognize. A stroll through an emergency department with patient stretchers in all the hallways, with conference rooms and offices converted to patient care space, a crowded waiting room, and harried nurses and physicians is clearly a walk through an overcrowded department. More specifically, a number of circumstances are widely recognized as signs of overcrowding. These include (1) patients’ having to wait longer than 90 minutes to see a physician, (2) all department beds being filled with patients more than six hours per day, (3) patients’ being placed in the hallways more than six hours a day, (4) more than 30% of department beds being filled with patients who are ‘‘admitted’’ to the hospital, and (5) having a full waiting room with no place for new patients more than six hours per day.