According to a study published online recently in Annals of Emergency Medicine (“National Trends in Emergency Department Occupancy, 2001-2008: Impact of Inpatient Admissions Versus Emergency Department Practice Intensity”), visits to emergency departments increased faster than population growth over an eight-year period, and occupancy – or crowding – grew even more rapidly.

The report states that during the study period, the number of ED visits increased by 1.9% per year, a rate 60% faster than population growth. Mean occupancy increased even more rapidly, at 3.1% per year. The report also notes that among the potential factors associated with crowding, the use of advanced imaging increased most, by 140%. But advanced imaging had a smaller effect on the occupancy trend than other more common throughput factors, such as the use of intravenous fluids and blood tests, the performance of any clinical procedure, and the mention of two or more medications.

The study's conclusion sums the problem up nicely, stating:

Despite repeated calls for action, ED crowding is getting worse. Sociodemographic changes account for some of the increase, but practice intensity is the principal factor driving increasing occupancy levels. Although hospital admission generated longer ED stays than any other factor, it did not influence the steep trend in occupancy.

So how does the healthcare design community change the way that EDs are designed to combat this problem? I suspect that because the factors in play here are so common, the problem may, in fact, lay elsewhere -- namely in the efficiency of the hospital process itself. Given the above stated potential factors, colocation of services with the ED -- or even locating the services in question within the ED -- would seem to be the logical step to take, but as we all know, designers can only design things to be used properly and efficiently; they can't actually go there and do the work. Perhaps the problem here is more operational in nature?

In any case, what innovative solutions have you seen -- or simply thought of -- that might help the situation of overcrowded EDs? Post your thoughts below, or send me an e-mail by clicking here.