title: System dynamics and dysfunctionalities: levers for overcoming emergency department overcrowding.
abstract: Overcrowding of U.S. emergency departments (EDs) is a widely recognized and growing problem. This presentation offers the perspectives of a primary care physician (PCP) examining the problem at three levels: global health policy, quality process improvement, and more intimate clinical caring. It posits that ED overcrowding is actually a symptom of 10 more fundamental problems in U.S. health care and EDs: variations/supply-demand mismatch; primary care provider shortfalls; limited after-hours access; admission throughput challenges; clinical challenges related to discontinuity patients; clinical challenges related to those with special needs; interruptions; testing logistical challenges; suboptimal information systems; and fragmented/dysfunctional health insurance system, leaving many un- and underinsured.
authors.affiliation: Brigham and Women's Hospital Center for Patient Safety Research and Practice, Division of General Medicine/Primary Care Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. gschiff@partners.org
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
mesh_terms: D003441:Crowding; D004635:Emergency Medicine / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009936:Organizational Innovation; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States