In developments that are already common in Canada, American emergency departments (EDs) are periodically shutting down, diverting ambulances and forcing patients to wait longer for beds.
Sixty percent of the nation's EDs are now operating at or over capacity, and 90% of hospitals with more than 300 beds are full or over capacity. The main causes appear to be nursing shortages and shrinking capacity within the emergency care system.
The data emerged from a survey conducted by the American Hospital Association (AHA), in which nearly 90% of trauma centres reported being “overwhelmed” and more than half of urban EDs reported that they have been closed to ambulance admissions at some time.
The survey also found that a trained-worker shortage has become a major contributing factor in the diversion of ambulances — an average of 16% of nursing positions are going unfilled.
Although ED overcrowding is occurring across the country, it is most acute in large urban centres. This is especially true in the northeast, where 52% of EDs report being beyond their capacity. The AHA also reports that the number of hospitals in the US has shrunk by 14% since the mid-1980s and the number of beds has dropped by 18%. Meanwhile, outpatient visits have increased by almost 16% since 1997.
Another survey, released by the US Centers for Disease Control and Prevention, found that Americans made 108 million visits to hospital emergency departments in 2000, up 14% from 1997. However, because the number of EDs decreased from 4005 to 3934 during the same period, the number of visits per ED actually rose by 16% and the average waiting time for patients making nonurgent visits increased by one-third, from 51 minutes in 1997 to 68 minutes in 2000.
This growing use of EDs to supply nonurgent services is considered a key indicator of the difficulty many low-income Americans have in gaining access to primary care, largely because they have no health insurance. — Milan Korcok, Florida