US Emergency Care in Crisis

Ann Emerg Med

The nation’s emergency care system is in a state of crisis, according to 3 new reports from the Institute of Medicine (. 2006; 48:115-120).

Severe overcrowding is a major issue. In 2003 there were 113.9 million emergency department visits, up from 90.3 million a decade earlier. At the same time, the number of US hospitals decreased by 703, the number of hospital beds decreased by 198,000, and the number of emergency departments decreased by 425.

Ten primary diagnoses accounted for approximately one third of the 16 million ambulance transports in 2003 (Figure); 37% of the transported patients were admitted to the hospital, adding to the overcrowding problems, as well as to a striking increase in the number of ambulance diversions. Approximately 500,000 times a year an ambulance is turned away from an emergency department that is full and sent to another facility. The American Hospital Association reports that almost 50% of all hospitals and nearly 70% of urban hospitals diverted patients in 2004.