Danger at the Emergency Room

Indebted, Overcrowded, and Understaffed ERs

Even on a Thursday afternoon, in an affluent suburb of Los Angeles, the 15-bed emergency room at Encino-Tarzana Regional Medical Center is packed. While more than two dozen people sit in the waiting room, inside every bed is filled, corridors are clogged with stretchers and equipment, and sick and injured patients are waiting to be examined by a doctor.

The scene is chaotic. One bed holds a wailing 6-year-old girl who knocked out a front tooth in a playground accident, while a frightened middle-aged woman in another bed is vomiting after having had a seizure. Nearby, a young mother cradles her sickly, feverish newborn. In the hallway, two beefy paramedics wait for a gurney to become available so they can transfer a dazed elderly woman who suffered a fall, and then leave for their next emergency call.

Behind the nurse's station sit an elderly man and his wife who have been in a fender bender. Her forehead and lip are badly cut and her chin and blouse are covered with blood. "Having them wait in chairs, instead of lying down in a bed, isn't ideal, but we need to monitor her head injury and there's just no other place to put them," says G. Scott Brewster, MD, one of the two ER doctors on duty. He orders a CT scan to check for possible brain damage.

But an hour will pass before the scanner is available and a nurse can escort the patient to the hospital's imaging center.

"Hospitals like ours are trying to be as efficient as possible, but the overcrowding keeps getting worse," says Dr. Brewster. The numbers bear him out: Between 1993 and 2003, the annual number of emergency department visits increased 26 percent, from 90.3 million to 113.9 million, according to the Centers for Disease Control and Prevention (CDC), in Atlanta. This growth is driven in part by the increasing numbers of older Americans, who tend to have chronic medical conditions that take more time to diagnose and treat, and by the nation's swelling ranks of uninsured, which now top 45 million.

But the real problem is that during this same period, the number of hospital emergency departments decreased by about 14 percent, leaving the nation's remaining 4,000 ERs to serve a larger volume of patients than ever before.