Crowded ERs lead to more complications

Anybody who watches TV and has seen at least an episode of ER or Grey’s Anatomy is familiar with the scene – an emergency room. The TV shows portray the ER as a scene of constant activity and sometimes chaos – organized chaos maybe – but still chaos. Most of the patient stories end up well but some don’t. It’s like that in real life, too.

According to this study recently published in the journal Academic Emergency Medicine, “Patients with heart attacks and other forms of chest pain are three to five times more likely to experience serious complications after hospital admission when they are treated in a crowded emergency department (ED).” According to the authors, the complications do not occur during the emergency treatment as such but after the emergency patients have been admitted to the hospital.

The study tracked 4,574 patients who presented with symptoms of chest pains and were admitted to the Hospital of the University of Pennsylvania during a period of eight years. The follow up data showed the following figures:

• 802 were diagnosed with an acute coronary syndrome
• 273 of the 802 had heart attacks
• 251 complications occurred in the hospital after initial treatment in the emergency department

Furthermore, the rate of complications increases in relation to the extent of ED crowding. According to the authors

When the emergency department was at its highest occupancy and waiting room census, patients with acute coronary syndrome were three times more likely to experience complications in the hospital. When the ‘patient-hours’ was highest, they were more than five times more likely to have a complication.

Patient-hour is a measure of real ED workload and is the sum of the total hours that all patients in the emergency department have been waiting.

Complications reported ranged from mild to serious and included heart failure, delayed heart attacks, dangerously low blood pressure, heart arrhythmias and cardiac arrest.

It is estimated that more than six million Americans go into an emergency room each year for chest pains. The results of the study indicate that these ER-related complications should be taken seriously and considered a major health care concern. The cause of the problem is not easy to pinpoint but the authors hypothesized the following:

• poor coordination of care
• delays in conducting tests
• overloaded doctors, nurses and other health professionals

In the end, the problem lies not only in emergency care. Overcrowding in the emergency department is simply an indication of a “dysfunctional hospital.”

Photo credit: stock.xchng