Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003-04.

OBJECTIVE: The increased demand for emergency department (ED) services over the past decade has resulted in crowding. This report presents estimates of structure and process characteristics of hospital EDs related to their capacity to treat medical and surgical emergencies. Estimates of EDs experiencing crowded conditions are also presented.

METHODS: Several facility supplements were added to the 2003-04 National Hospital Ambulatory Medical Care Survey (NHAMCS), which were completed by hospital staff. NHAMCS samples nonfederal, short-stay, and general hospitals in the United States. Of all sample hospitals that operated 24-hour EDs, 83 percent completed the supplemental questionnaires. Data from 467 hospitals were weighted to produce national annual estimates of ED characteristics.

RESULTS: There was an annual average of 4,500 EDs operating in the United States during 2003 and 2004. Over one-half of EDs saw less than 20,000 patients annually, but 1 out of 10 had an annual visit volume of more than 50,000 patients. Although 16.1 percent of hospitals expanded their ED physical space within the last 2 years, approximately one-third of others planned to do so within the next 2 years. Most EDs used outside contracts to provide physicians (64.7 percent). One-half of EDs in metropolitan statistical areas (MSAs) had more than 5 percent of their nursing positions vacant. Of all on-call specialists, the services of plastic and hand surgeons were most frequently reported as somewhat or very difficult to obtain (49.4 percent). Approximately one-third of U.S. hospitals reported going on ambulance diversion sometime in the previous year. About 12 percent of hospitals in MSAs reported having spent between 5 and 19 percent of their operating time in diversion status. Between 40 and 50 percent of U.S. hospitals experienced crowded conditions in the ED with almost two-thirds of metropolitan EDs experiencing crowding.