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ER overcrowding: A crisis for health workers and the public

Nurse burnout has been a problem for years, but things took a turn for the worse in 2020 with the onset of the COVID-19 pandemic.

NEW HAVEN, Conn. — First COVID, and this winter, add the respiratory virus RSV and the flu. Emergency rooms across the country are bursting. ER overcrowding has been a health care problem for years, but now, health experts say it's reaching crisis levels. 

Imagine racing into your local emergency room and you wait not minutes, but hours to be seen, then ER doctors admit you to the hospital, but there are no beds at all.

Yale School of Medicine emergency room physician Arjun Venkatesh, M.D. and his colleagues have documented widespread and increasing overcrowding. In a pair of newly published studies, the researchers looked first at the length of time patients waited in the ER before they were admitted.

“Those who come to the emergency department are evaluated, they receive diagnostics and treatments, and then, they need inpatient hospitalization," Dr. Venkatesh said. "They need to stay in the hospital and are waiting two, three, four, up to 12 and 24 hours for a bed in the hospital."

Researchers said that wait time, called boarding time, is well above the national recommendation, which is no more than a four-hour wait. As a result, Dr. Venkatesh said one out of every ten patients winds up walking out.

The researchers say a healthcare worker shortage is contributing to hospital overcrowding – leading to longer ER wait times. Dr. Venkatesh said hospitals may need to rethink how they deliver health care.

“We have to figure out how to get people back to the bedside who have the training and the skills to do it," said Venkatesh. "And maybe, we start using artificial intelligence, computer technologies, other tools that we have to do the back office work so that those people can be taking care of patients and be more effective at doing that."

Earlier studies have found that emergency department overcrowding leads not only to treatment delays but also prolonged disease and death. For health care workers, overcrowding leads to higher doctor and nurse turnover, and higher burnout. And in a new study published in December, researchers found that overworked ER doctors may be misdiagnosing patients coming through the doors.

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