Rising Pressure: Hospital Emergency Departments as Barometers of the Health Care System

Originally published by the Center for Studying Health System Change (HSC), 2005.

Emergency Departments as Barometers of the Health Care System

Hospital emergency departments were facing rising pressure from multiple directions, functioning as barometers of broader health care system stress, according to HSC research. Emergency department overcrowding had become a growing concern in communities across the country, driven by a combination of factors including growing numbers of uninsured patients who lacked access to primary care, difficulty transferring psychiatric patients to appropriate settings, boarding of admitted patients in ED hallways because of full inpatient beds, and increasing ED visits by insured patients who could not get timely appointments with their primary care physicians.

The pressure on emergency departments reflected systemic failures elsewhere in the health care system. When primary care access was inadequate, patients turned to EDs for care that could have been provided more appropriately and at lower cost in office settings. When psychiatric beds were scarce, ED boarding of psychiatric patients consumed resources and staff time. When hospital inpatient capacity was tight, admitted patients waiting for beds backed up into the emergency department, reducing available space for new patients and lengthening wait times. Addressing ED overcrowding required tackling these upstream problems rather than focusing solely on the emergency departments themselves.

Sources and Further Reading

Center for Studying Health System Change, "Rising Pressure: Hospital Emergency Departments as Barometers of the Health Care System" (2005).