There has been much discussion in the past week about Canadian emergency departments functioning with occupancy rates of anywhere from 120-200%. This has been suggested to be associated with the most recent flu outbreak which indeed are stressing EDs across North America. But to be clear, overcrowded hospitals leading to emergency departments functioning at overcapacity is a chronic and non-seasonal issue.
British modelling studies on ED crowding have suggested that hospitals functioning at 85% occupancy never see crowding, those at 90% bed occupancy will occasionally see crowding and at 95% ED crowding is a given. Despite this, Canadian hospitals over the past decade often function at 100% occupancy at least.
A recent report from Regina, Saskatchewan practically lauded over the statistic that they are now functioning at 115% bed occupancy rates as if that were something to be proud of. It isn’t.
We need to be reminded of the direct consequences of ED crowding (which is a direct function of hospital crowding):
“Moral Consequences” – as defined by Moskop et Al in the May 2009 edition of the Annals of Emergency Medicine
– increased patient waiting times
– lack of privacy and confidentiality
– impaired evaluation and treatment
– difficulties in delivering patient centered care
All key components of providing the moral care expected in a physician-patient relationship.
– increased rates of patients who leave without being seen
– delays in providing care (antibiotics for pneumonia, time to thrombolysis for myocardial infarctions)
– increased frequency of sentinel events in which there is unexpected occurrences involving death or serious physical or psychological injury
– increased in-patient mortality rates
– increased risk of medical error
– increased risk of patient pain and anxiety (making patients suffer unnecessarily)
– increased infectious disease risk to baorded elderly patients
– increased costs to the health care system
– delays in ambulance off-loading
– ambulance diversion
– system gridlock
Consequences to the Care Provision Team:
– decreased job satisfaction
– burnout with prematurely shortened careers
– increased exposure to violence
Far from being a matter of mere patient inconvenience, as often portrayed by governments, the simple truth is that ED crowding fundamentally threatens the welfare of patients and increases their risk of poor outcomes.
We have a moral obligation to our patients and to society to continue to highlight the very real threat of Hospital crowding and its attendant stress on emergency departments to the public health of our nation.