It reported that it is not uncommon for patients to be “boarded” in the ER for 48 hours or more until an inpatient bed becomes available. It documented that ambulance diversion was occurring roughly one-half million times per year in the United States, about once every minute. The Institute of Medicine report titled “Hospital-Based Emergency Care at the Breaking Point” evaluated the impact of ER crowding. A 2010 survey by the American Hospital Association revealed that more than 50% of surveyed urban and teaching hospitals had ERs that were “at” or “over” capacity ( Figure 1) ( 3).Įmergency Department Visits, Emergency Department Visits per 1,000, and Number of Emergency Departments, 1991–2009. The legislation sets forth no provisions for reimbursement.Īlthough most hospital types are affected, the crowding problem is particularly severe in urban and teaching hospitals. It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status, or ability to pay. The Emergency Medical Treatment and Active Labor Act, better known as EMTALA, was passed by Congress in 1986. Hospital-based emergency care is the only medical treatment to which Americans have a legal right, regardless of their ability to pay ( 2). For many Americans, it is now a place of last and first resort. By default, ERs have become, as noted in the 2006 Institute of Medicine report, “the safety net of the safety net” ( 1).
In the United States healthcare system, ER visits account for 11% of outpatient encounters, 28% of acute care visits, and 50% of hospital admissions. Crowding, delays, and diversions have increased to epidemic proportions. America's emergency rooms (ERs) are in crisis.