title: Emergency department crowding, part 2--barriers to reform and strategies to overcome them.
abstract: Part 1 of this 2-article series reviews serious moral problems created by emergency department (ED) crowding. In this second part of the series, we identify and describe operational and financial barriers to resolving the crisis of ED crowding, along with a variety of institutional and public policy strategies proposed or implemented to overcome those barriers. Finally, the article evaluates 2 additional actions designed to address the problem of ED crowding, namely, distribution of a warning statement to ED patients and implementation of a "reverse triage" system for safe early discharge of hospital inpatients.
authors.affiliation: Department of Medical Humanities, The Brody School of Medicine, and Bioethics Center, University Health Systems of Eastern Carolina, Greenville, NC 27834, USA. moskopj@ecu.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Moskop
authors.forename: David P
authors.initials: DP
authors.lastname: Sklar
authors.forename: Joel M
authors.initials: JM
authors.lastname: Geiderman
authors.forename: Raquel M
authors.initials: RM
authors.lastname: Schears
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Bookman
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D018166:Health Care Reform; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006742:Hospital Bed Capacity; D006801:Humans; D009014:Morals; D010351:Patient Discharge / Q000706:statistics & numerical data; D011640:Public Policy; D014218:Triage / Q000379:methods