During the past decade, hospital emergency departments have been faced with conditions resulting in overcrowding. These issues have ranged from an increase in nonurgent patients' overutilization of the system to a lack of acute care beds for stabilized and admitted patients. Federal, state, and local agencies have conducted a number of studies to assess the issues and develop and initiate various mechanisms to reduce ED overcrowding. Although these initiatives made an impact, the issue continues to generate national attention without the needed federal assistance.
Functioning as a staff nurse in emergency departments during the past 19 years has been rewarding as well as challenging. In the 80s, private hospitals competed for insurance products in an attempt to increase ED visits and net revenues. Public hospitals were stressed, and the federal government responded with the implementation of the Emergency Treatment and Labor Act as part of the Consolidated Omnibus Budget Reconciliation Act of 1986. This act made certain that any American in need of emergency treatment or in labor would receive treatment regardless of payor source. As a result, emergency departments went through a period where the “screening” process was followed; however, due to the litigious health care environment, many physicians did not want to assume the risk associated with only “screening” patients and referring for treatment.
ED visits continued to escalate, and overcrowding was witnessed by the private and public sectors. The system has analyzed and developed various methods to decrease overcrowding—development of fast tracks, tracking systems, charting systems, development of regional centers, etc.—and process this population more efficiently. Causes of the problem are consolidated to lack of ED space, an increase in nonurgent patients utilizing the emergency room, lack of acute care beds, and lack of qualified nursing staff.
The federal government has attempted to address the nurse staffing issue with the Nurse Reinvestment Act of 2002. Although the act has not solved the problem, which is expected to get worse, it is time for the federal government to examine mechanisms to improve primary care access and increase acute care beds. The government has spent billions of dollars on defense and foreign affairs without addressing this American crisis. Medical personnel have been victims of criminal charges for quality of care issues as they relate to emergency room overcrowding and continue to focus on mechanisms to solve the crisis without being provided the resources to alleviate the crisis. The federal government needs to provide some assistance to the system as it did with the Hill-Burton Act. The American population has grown, and acute care hospitals have been mandated to provide primary and emergency care in emergency departments. The population continues to age, requiring more acute care hospital beds. Does this country really possess the number of staffed hospital beds per 1000 people? When we are boarding admitted patients in the emergency department and transferring patients across state lines and to other facilities, this is certainly not the case. If we can obtain the necessary funding to increase the number of beds and utilize charity care accounts as a means of forgiveness, this would increase the number of acute care beds available and resultantly decrease the ED wait times.
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