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Hospital emergency department capacity may be reaching its limits

Emergency physicians fear increased gridlock as already overcrowded facilities brace for flu season.

By Kathleen F. Phalen, amednews correspondent. Jan. 15, 2001.

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Emergency departments around the nation are stretched to capacity, so doctors expect the unexpected -- even a wild card like this year's flu season -- to upset an already fragile situation.

"Staff is pushed to the edge when they are wall-to-wall with the critically ill [patients] and more are en route. ... During the last flu outbreak, eight, nine, 10 metropolitan acute care hospitals were on diversion at one time," says Arthur Kellerman, MD, chair of the Dept. of Emergency Medicine at Emory University School of Medicine in Atlanta, and a member of the board of the American College of Emergency Physicians. "We thought the situation would abate after the flu season, but it didn't.

"When there aren't enough staffed hospital beds, the system backs up and we get on the verge of gridlock. Around the nation, there are thousands of sick and injured patients in hallways with nowhere to go."

A number of issues -- funding, staffing, patients' lack of insurance -- contribute to what Dr. Kellerman calls gridlock. But, as he explains, emergency department overcrowding is really a symptom of an inpatient problem. "It's not a matter of just buying more gurneys or ambulances," he says. "There just aren't enough acute care beds to meet the need, so [those patients] get boarded in the ED. At that point, staff is working under incredible stress. If we had available staffed beds in the hospital, there would be no overcrowding. The system works beautifully when the inpatient system is working."

With the flu season coming late this year, it's hard to predict what will happen, says Michael Osterholm, PhD, chair of the Emerging Infections Committee of the Infectious Diseases Society of America. "Clearly there are a variety of different situations by geographic area, but guesstimates are that at least half of the country is experiencing this situation," he says. "We're trying to prepare, but we don't really know the extent of the problem and, unfortunately, infectious diseases represent the unexpected." [...]