Report Details Overcrowding in State’s Emergency Rooms
As a worrisome number of emergency rooms and entire hospitals closed in California over the last decade, the remaining emergency care facilities had to handle a significant rise in the number of patients, according to a study released Thursday.
The overcrowding in many emergency units is not being caused by people arriving there with minor ailments, despite some impressions to the contrary. The report found that the number of patients visiting emergency departments with serious health problems rose by 59% from 1990 to 1999. Non-urgent visits to emergency rooms actually dropped by 8%.
The study, published in the April issue of the Annals of Emergency Medicine, noted a 12% decrease statewide in the number of emergency departments, from 407 to 357. The number of patient visits to emergency departments increased 27% during the same period.
Other hospitals added capacity to their emergency facilities, and the overall ratio of emergency department beds increased slightly in the 1990s, from 14.5 to 15.3 per 100,000 Californians. But Dr. Susan Lambe, author of the study and an assistant professor at UC San Francisco, said there was little reason to celebrate that ratio. “From a practical standpoint, it certainly doesn’t do much,” she said.
“Probably the most significant and most surprising finding,” Lambe said, was the increase in seriously sick people using emergency rooms.
“That goes against the suggestion that non-urgent patients are causing trouble,” she said.
Dr. Marshall Morgan, chief of emergency medicine at UCLA Medical Center, said most emergency physicians he’s spoken to “feel that the emergency care system is in a state of crisis. We’re kind of holding on by our fingernails.”
Morgan, who is familiar with the report’s findings, said his unit has not increased its formal number of beds in recent years but found ways to increase its capacity.
“We’ve taken the conference room and modified it in a way that we can see patients,” he said. “We use it as a conference room during the day, then around 3 o’clock we move in the gurneys, pull the curtains out and use it to see patients. And they still wait too long.”
Dr. Brent Asplin, a researcher at Regions Hospital in St. Paul, Minn., who wrote an editorial to accompany the study, said the decrease in emergency departments causes an array of problems at hospitals.
“Patients who are triaged with less urgent conditions wait longer for care,” Asplin said. “The patients who are in the hospital are still getting care, but because of the concentration of patients ... our ability to take new patients is sometimes compromised.”
The study analyzed data from California’s Office of Statewide Health Planning and Development, which details all hospital and health service facilities in the state.
“Our emergency departments are overburdened, and if you walk into any emergency department on any given day, you’ll find that’s true,” said Brian Johnston, medical director of the emergency department at White Memorial Medical Center in Los Angeles.
