Emergency Departments in Crisis: Opportunities for Research

Emergency Departments in Crisis: Opportunities for Research
Nov 13 CDPH Team

Carolyn M Clancy

Health Services Research

Although large-scale events such as the September 11 attacks and Hurricane Katrina have heightened awareness and concerns about the ability of our emergency system to handle large-scale events, it is clear that emergency rooms in the country are barely able—and in many cases unable—to handle current, every day demand for their services.

Any one who has been to an emergency department recently can attest to the long waits for care. This anecdotal view is borne out by 2004 data from the Centers for Disease Control and Prevention (McCaig and Nawar, 2006):

  • One-fifth of the nation’s population had made one or more emergency department visit within the previous 12 months.
  • Approximately 10 percent of all ambulatory medical care visits in this country occurred in emergency departments.
  • There were about 209 emergency department visits every minute across the United States (Machlin, 2006).
  • From 1994 to 2004, the rate emergency departments use increased by 6 percent, from 36.0 to 38.2 visits per 100 persons.

Data from AHRQ’s National Healthcare Quality Report (2006) adds to the picture of emergency care in the United States:

  • In 2004, 1.8 percent of emergency department patients left before being seen.
  • In 2004, about a quarter of patients admitted to the hospital from an emergency department spent more than 6 hours in the emergency room.

In recent reports, the Robert Wood Johnson Foundation has described hospital emergency departments as “bursting at the seams,” while the Institute of Medicine (IOM) entitled one of three recent reports on emergency care in the United States Hospital—Based Emergency Care: At the Breaking Point (IOM, 2006).

In this commentary, I would like to describe some recent findings of this IOM report, highlight some existing AHRQ activities in this area, and discuss some research questions posed by the IOM and which the readers of this journal might consider pursuing. As the leading health services researchers in the world, the readers of HSR can contribute greatly to the body of research that will inform efforts to improve the quality, safety, efficiency, and effectiveness of emergency room care.