Editing Emergency department (section)

==Overcrowding==
Emergency department overcrowding is when function of a department is hindered by an inability to treat all patients in an adequate manner. This is a common occurrence in emergency departments worldwide.<ref name="triage">{{cite journal | vauthors = Aacharya RP, Gastmans C, Denier Y | title = Emergency department triage: an ethical analysis | journal = BMC Emergency Medicine | volume = 11 | pages = 16 | date = October 2011 | pmid = 21982119 | pmc = 3199257 | doi = 10.1186/1471-227X-11-16 | doi-access = free }} {{open access}}</ref> Overcrowding causes inadequate patient care which leads to poorer patient outcomes.<ref name=triage/><ref name="pmid12954674">{{cite journal | vauthors = Trzeciak S, Rivers EP | title = Emergency department overcrowding in the United States: an emerging threat to patient safety and public health | journal = Emergency Medicine Journal | volume = 20 | issue = 5 | pages = 402–5 | date = September 2003 | pmid = 12954674 | pmc = 1726173 | doi = 10.1136/emj.20.5.402 }}</ref> To address this problem, escalation policies are used by emergency departments when responding to an increase in demand (e.g., a sudden inflow of patients) or a reduction in capacity (e.g., a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes.<ref>{{cite journal | vauthors = Back J, Ross AJ, Duncan MD, Jaye P, Henderson K, Anderson JE | title = Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience | journal = Annals of Emergency Medicine | volume = 70 | issue = 5 | pages = 659–671 | date = November 2017 | pmid = 28662909 | doi = 10.1016/j.annemergmed.2017.04.032 | s2cid = 4228726 | url = https://kclpure.kcl.ac.uk/portal/files/72038931/Emergency_Department_Escalation_in_Theory_and_Practice_A_Mixed_Methods_Study_Using_a_Model_of_Organizational_Resilience_2017.pdf | doi-access = free }} {{open access}}</ref>

In recent years, there has been a rise in ER [[overcrowding]] that often leads to patients being treated in unsafe conditions. ER overcrowding is a risk for patient care, rising [[health care]] costs, and several hour long waits for [[hospital bed]]s that don't exist.

===Emergency department waiting times===
Emergency department (ED) waiting times have a serious impact on patient mortality, morbidity with [[Hospital Readmission|readmission]] in less than 30 days, length of stay, and patient satisfaction. The probability of death increases each 3 minutes for 1% in case of major injuries in the abdomen part. (Journal of Trauma and Acute Care Surgery<ref>{{Cite journal|title=Time to Laparotomy for Intra-abdominal Bleeding from Trauma Does Affect Survival for Delays Up to 90 Minutes|journal=Journal of Trauma and Acute Care Surgery|date=March 2002|volume=52|issue=3|pages=420–425|last1=Clarke|first1=John R.|last2=Trooskin|first2=Stanley Z.|last3=Doshi|first3=Prashant J.|last4=Greenwald|first4=Lloyd|last5=Mode|first5=Charles J.|doi=10.1097/00005373-200203000-00002|pmid=11901314}}</ref>) Equipment in emergency departments follows the prompt treatment principle with the least possible patient transfers from admittance to X-ray diagnostics. A review of the literature bears out the logical premise that since the outcome of treatment for all diseases and injuries is time-sensitive, the sooner treatment is rendered, the better the outcome.<ref>{{cite journal | vauthors = Carter EJ, Pouch SM, Larson EL | title = The relationship between emergency department crowding and patient outcomes: a systematic review | journal = Journal of Nursing Scholarship | volume = 46 | issue = 2 | pages = 106–15 | date = March 2014 | pmid = 24354886 | doi = 10.1111/jnu.12055 | pmc = 4033834 }}</ref><ref>{{cite web|publisher=Ontario Ministry of Health and Long Term Care |date=2008 |title=Ontario Wait Times |url=http://www.health.gov.on.ca/en/pro/programs/waittimes/edrs/strategy.aspx |archive-url=https://web.archive.org/web/20150813012626/http://www.health.gov.on.ca/en/pro/programs/waittimes/edrs/strategy.aspx |archive-date=13 August 2015 |access-date=18 February 2022 }}</ref> Various studies reported significant associations between waiting times and higher mortality and morbidity among those who survived.<ref>{{cite journal | vauthors = Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA | title = Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada | journal = BMJ | volume = 342 | pages = d2983 | date = June 2011 | pmid = 21632665 | pmc = 3106148 | doi = 10.1136/bmj.d2983 }}</ref> It is clear from the literature that untimely hospital deaths and morbidity can be reduced by reductions in ED waiting times.<ref>{{cite web | first = Thomas A. | last = Sharon | name-list-style = vanc | publisher = Locatible Health Tech Hub | url = http://locatible.com/blog/higher-ed-waiting-times-cause-higher-mortality-houskeepers-cards/ | title = Shortening Emergency Department Waiting Times through Evidenced-Based Practice | date = 7 September 2015 | access-date = 7 September 2015 | archive-date = 10 April 2016 | archive-url = https://web.archive.org/web/20160410005409/http://locatible.com/blog/higher-ed-waiting-times-cause-higher-mortality-houskeepers-cards/ | url-status = dead }}</ref>

===Exit block===
A significant proportion of emergency patients are discharged after treatment, but many require admission for ongoing observation, treatment, or to ensure adequate social care before discharge. If patients requiring admission cannot be placed in inpatient beds swiftly, "exit block" or "access block" occurs. This often leads to crowding and can lead to delays in treatment for newly presenting cases ("arrival access block").<ref name=Mason2017>{{cite journal | vauthors = Mason S, Knowles E, Boyle A | title = Exit block in emergency departments: a rapid evidence review | journal = Emergency Medicine Journal | volume = 34 | issue = 1 | pages = 46–51 | date = January 2017 | pmid = 27789568 | doi = 10.1136/emermed-2015-205201 | s2cid = 13719212 | url = http://eprints.whiterose.ac.uk/106814/22/Exit%20Block%20in%20Emergency%20Departments.unmarked.pdf }}</ref> This is more common in densely populated areas and affects adult departments more than pediatric ones.<ref name=Mason2017/> Exit block can lead to delays for the patients awaiting inpatient beds ("boarding") and also for new patients arriving at an exit-blocked department. Proposed solutions include changes in staffing or increasing inpatient capacity.<ref name=Mason2017/>

===Frequent users===
Frequent emergency service users are individuals who present themselves at a hospital much more often than non-frequent presenters.<ref name="pmid22171720222">{{cite journal |vauthors=Markham D, Graudins A |date=December 2011 |title=Characteristics of frequent emergency department presenters to an Australian emergency medicine network |journal=BMC Emergency Medicine |volume=11 |pages=21 |doi=10.1186/1471-227X-11-21 |pmc=3267650 |pmid=22171720 |doi-access=free}}</ref> Many frequent users are homeless individuals seeking shelter and food at the hospital.<ref>{{Cite web |last=Burling |first=Stacey |date=2018-06-28 |title=Shelters, hospitals 'playing ping pong' with Philadelphia's homeless, sick population |url=https://www.inquirer.com/philly/health/homeless-shelters-philadelphia-hospitals-medical-care-temple-jefferson-20180628.html |access-date=2023-09-27 |website=www.inquirer.com |language=en}}</ref> Federal laws and regulations in the United States, like [[EMTALA]] and [[HIPAA]], limit the options of hospital personnel when an individual presents to the ER with a fabricated problem.<ref>{{Cite web |title=Emergency Medical Treatment & Labor Act (EMTALA) {{!}} CMS |url=https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act |access-date=2023-09-27 |website=www.cms.gov}}</ref> These individuals do not account for a significant number of visits but typically require a disproportionate amount of hospital resources.<ref name="pmid10905642222">{{cite journal |vauthors=Mandelberg JH, Kuhn RE, Kohn MA |date=June 2000 |title=Epidemiologic analysis of an urban, public emergency department's frequent users |journal=Academic Emergency Medicine |volume=7 |issue=6 |pages=637–46 |doi=10.1111/j.1553-2712.2000.tb02037.x |pmid=10905642}}</ref> To help prevent inappropriate emergency department use and return visits some hospitals offer care coordination and support services such as at-home and in-shelter transitional primary care for frequent users and short-term housing for homeless patients recovering after discharge.<ref>{{cite web |date=27 May 2013 |title=Provider Team Offers Services and Referrals to Frequent Emergency Department Users in Inner City, Leading to Anecdotal Reports of Lower Utilization |url=https://innovations.ahrq.gov/profiles/provider-team-offers-services-and-referrals-frequent-emergency-department-users-inner-city |access-date=17 October 2013 |publisher=Agency for Healthcare Research and Quality}}</ref><ref>{{cite web |date=23 October 2013 |title=Short-Term Housing and Care for Homeless Individuals After Discharge Leads to Improvements in Medical and Housing Status, Fewer Emergency Department Visits, and Significant Cost Savings |url=https://innovations.ahrq.gov/profiles/short-term-housing-and-care-homeless-individuals-after-discharge-leads-improvements-medical |access-date=23 October 2013 |publisher=Agency for Healthcare Research and Quality}}</ref>

===Telemedicine===
A study found that [[Telehealth|telemedicine]] services in Saudi Arabia were effective in reducing emergency department overload by providing medical advice to patients with less urgent medical issues.<ref>{{cite journal | doi=10.1177/20552076221091358 | title=The role of telemedicine services in changing users' intentions for presenting to the emergency departments in Saudi Arabia | year=2022 | last1=Alfaleh | first1=Amjad | last2=Alkattan | first2=Abdullah | last3=Alageel | first3=Alaa | last4=Salah | first4=Mohammed | last5=Almutairi | first5=Mona | last6=Sagor | first6=Khlood | last7=Alabdulkareem | first7=Khaled | journal=Digital Health | volume=8 | pmid=35694122 | pmc=9185009 | s2cid=249530467 }}</ref>