Study Finds Minorities Most Affected by ED Overcrowding

Emergency department overcrowding at California hospitals disproportionately affects minority populations, according to a study published in the journal Health Affairs, the San Francisco Chronicle reports (Colliver, San Francisco Chronicle, 8/6).

For the study, researchers from UCLA, UC-San Francisco and Stanford University measured hospital overcrowding in 202 California facilities (Yeung, California Watch, 8/6). The researchers examined how often ambulances were diverted to other facilities in 2007.

Key Findings

The study found that hospitals serving the largest percentage of minority patients diverted ambulances because of overcrowding up to four times as often as facilities that served the smallest percentage of minority populations.

Researchers noted that ambulance diversion can delay care and lead to poorer health outcomes.

According to the study, EDs become overcrowded for various reasons, including:

• A lack of proper staffing to admit patients to the hospital;
• A lack of proper equipment or services needed to treat a specific medical problem; and
• Use for non-emergency care by patients who are uninsured or do not have adequate access to primary care services.

In addition, the researchers noted that ED overcrowding is caused by larger issues within the health care system, including:

• Hospitals being overwhelmed by poorer patients; and
• Facilities needing better emergency management (San Francisco Chronicle, 8/6).

The study concluded that "system-level policies, whether at the hospital or county level, regulating ambulance diversion may help policymakers, health care providers and hospital administrators reduce diversion and its associated inequalities."

Implications

Ellis Weeker -- vice president of CEP America and a practicing ED physician in San Jose -- said that many minorities use EDs because "they can't find a primary care physician to see them," adding, "The answer is not more hospitals or [EDs]; it's more alternatives for people that if you have a more routine medical problem, it doesn't need to be cared for in the [ED]."

Renee Hsia -- lead author of the study and an assistant professor of emergency medicine at UCSF -- said, "[I]f your hospital goes into diversion, it affects other hospitals." She added, "The effects are not just on patients in the [ED]; it's on people waiting for an ambulance that might be out of commission because it is circling the city (to get to a hospital that will accept the patient). The overall effects are felt by everybody" (California Watch, 8/6).

Broadcast Coverage