America's Hospitals: In Danger or Bouncing Back?

Slide Presentation by Robin Weinick, Ph.D.

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On November 20, 2002, Robin Weinick, Ph.D., made a presentation in a Web-assisted teleconference at Event 2, which was entitled "Emergency Department Overcrowding and Ambulance Diversion."

This is the text version of Dr. Weinick's slide presentation. Select to access the PowerPoint® slides (280 KB).

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Emergency Department Overcrowding and Ambulance Diversion

Robin Weinick, Ph.D.
Director, Intramural Research
Center for Primary Care Research
Agency for Healthcare Research and Quality

Slide 1

What is ED Overcrowding?

• Need for emergency services outstrips available resources in the ED.
• More patients than staffed ED beds, plus long wait times.
• Patients typically treated and monitored in hallways.
• Constrains ability to triage patients.

Slide 2

Measuring Overcrowding

• No established way to measure.
  • AHRQ is developing a set of measures.
• Time from arrival to physician contact.
• Number of patients being boarded.
• Boarding time.
• Time on ambulance diversion.

Slide 3

Ambulance Diversion

• Closed to ambulance traffic.
  • A symptom, not the primary problem.
• Results in:
  • Increased ambulance cycle/response time.
  • More first-time patients.
  • Forced override.
• Measured by the number of hours on divert.

Slide 4

Percent of Hospitals "At" or "Over" Capacity

This bar graph provides percentages of four different types of hospitals that reported being "at" or "over" capacity in 2002. The types of hospitals and the percentage reporting capacity issues are as follows: 79% of all urban hospitals; 45% of rural hospitals; 81% of teaching hospitals; and 56% of non-teaching hospitals. Nationally, 62% of all hospitals reported capacity issues.

Source: The Lewin Group Analysis of AHA ED and Hospital Capacity Survey, 2002.

Slide 5

Percent of Hospitals "At" or "Over" Capacity

The percentages of hospitals in the following groupings reported being "at" or "over" capacity: 34% of hospitals with less than 100 beds reported problems; 77% of hospitals with 100-299 beds were "at" or "over" capacity; 91% of hospitals with 300-499 beds reported capacity issues; and 90% of hospitals with more than 500 beds had capacity problems. In terms of trauma levels, 87% of level I hospitals reported capacity issues and 79% of level II reported capacity problems.

Source: The Lewin Group Analysis of AHA ED and Hospital Capacity Survey, 2002.

Slide 6

Time on Diversion

This graph shows the different amounts of time spent on diversion and the percentage of hospitals on diversion for that length of time. The information is as follows: 13% are on diversion 20% or more of the time; 10% are on diversion 10-19.9% of the time; 33% are on diversion up to 9.9% of the time; and 44% are not on diversion at all.

Slide 7

Factors Leading to Overcrowding:

• Increased demand.
• Reduced supply.
• Staffing shortage.

Slide 8

How Many ED Visits? 1992-2000

This bar graph tells how many visits were made nationwide to Emergency Departments. The number of visits by year are: 1992: 91 million; 1993: 90 million; 1994; 93 million; 1996: 90 million; 1998: 100 million; 2000: 108 million. The number of ED visits nationally has increased by 20% between 1996 and 2000.

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1992-2000.

Slide 9

How Many Hospital Beds? 1992-2000

This graph highlights the reduced supply of both hospital beds and Emergency Departments across the nation. From 1992-2000 there was an overall 16% decrease in the number of hospital beds and an 8% decrease in the number of Emergency Departments.

Source: American Hospital Association, Hospital Statistics.

Slide 10

How are Hospitals Staffed?

This slide shows the total number of new Registered Nurse graduates between 1995 and 2000. Highlighted on this slide is the fact that between 1995 and 2000, the number of new RNs has decreased by 26%.

Source: Health Resources and Services Administration, "Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020."

Slide 11

Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA)

"Home is the place where, when you have to go there, they have to take you in."

—Robert Frost, The Death of the Hired Man, 1915

Current as of June 2003

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Internet Citation:

Emergency Department Overcrowding and Ambulance Diversion. Slide Presentation by Robin Weinick, at Web-Assisted Teleconference, "America's Hospitals: In Danger or Bouncing Back?" Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/news/ulp/hospital/weinicktxt.htm

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