title: Overcrowding and diversion in the emergency department: the health care safety net unravels.
abstract: Emergency department overcrowding and diversion of patients are serious problems that are symptomatic of larger health care system issues. Downsizing, government regulations, managed care, increased numbers of uninsured, and reimbursement decreases are issues that have created the overcrowding and diversion issues. The Emergency Medical Treatment and Active Labor Act (EMTALA), poor operations and hospital processes, unavailable inpatient beds and closures, consolidations and workforce shortages are also contributors to the overcrowding and diversion issues. Options and solutions are proposed to alleviate the problem, however, greater collaboration, changed work environments, and reimbursement structures need to be developed and instituted. The safety net of the US health system is unraveling, and without intervention, the emergency department will not be able to provide services to the public at any level of quality and efficiency.
authors.affiliation: Emergency Nurses Association, 915 Lee Street, Des Plaines, IL 60016, USA. gvelianoff@ena.org
authors.forename: George D
authors.initials: GD
authors.lastname: Velianoff
mesh_terms: D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000706:statistics & numerical data; D005161:Facility Regulation and Control / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006754:Hospital Restructuring / Q000458:organization & administration; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration; D020380:Needs Assessment / Q000458:organization & administration; D010360:Patient Transfer / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D017751:Safety Management; D014481:United States