Recent Yale-led studies analyze the effects of overcrowded emergency healthcare facilities on patients.
Cate Roser, Contributing Illustrator
Emergency rooms across the country are severely overcrowded, with potentially catastrophic results for patients and healthcare professionals.
Two recent Yale co-studies, led by Arjun Venkatesh, Associate Professor and Chief of the Administration Section of the Department of Emergency Medicine, Alexander Janke, Visiting Scholar, and Edward Melnick, Associate Professor of Emergency Medicine and Biostatistics , identified the causes of emergency room overcrowding and analyzed the effects on patients.
A study examined the effect of hospital boarding on emergency department overcrowding. The other studied the monthly rates of patients leaving without care due to this overcrowding.
“We know [overcrowding] is not only uncomfortable – but also dangerous for patients and staff and results in the systematic denial of access to care to vulnerable populations,” Melnick said. “Many American ERs are operating in disaster mode on a daily basis…I hope the public will demand such action and accountability that emergency care is available to them and their loved ones when they need it.”
Emergency medicine has become a specialty 1960s when the exploding population in the United States needed an increasing amount of unscheduled and urgent care. Today, emergency medicine residency programs accept 2,000 students a year in the United States.
Almost all of these residents work in overcrowded emergency rooms. A study conducted by the Institute of Medicine found that before the pandemic, more than 90% of emergency departments in the United States reported overcrowding as a problem, and nearly 40% said overcrowding happened daily.
“When it hits a breaking point, it’s hard to make sure we’re giving everyone the best possible care,” said Karen Jubanyik, associate professor of emergency medicine at Yale School of Medicine.
Jubanyik broke studies. Ultimately, she explained, ER overcrowding comes down to one thing: boarding. Boarding is the process of finding a bed for patients, which involves holding patients in the emergency room before transferring them to an inpatient or observation unit.
“[Once the] the emergency department has decided that the patient needs to be admitted, there is no room for him in the hospital,” Jubanyik said.
Overall, the problem isn’t so much the lack of beds as it is the lack of staff. The federal government recommends, on average, a nurse-to-patient ratio of 1 to 5 to maintain proper patient care. Most of the time, there are empty beds to take patients to the emergency room, but there are not enough appropriate staff to take care of these patients.
When patients cannot be put in the room, they must stay in the emergency room.
“[It is] impossible to track the number of people in the ER,” said a Yale student volunteer at Yale New Haven Hospital, who was granted anonymity for fear of professional retaliation or dismissal.
According to Jubanyik, another patient once came in with an infection that required intravenous antibiotics. She was treated in a hallway for three days and “never even saw the inside of the hospital floor”. Jubanyik said there were “no showers, not the best possible nutrition, no privacy, no lights, no noise”. Although she received the care she needed and was able to leave the hospital, the lack of “good rest, good food” and a quiet environment slowed her recovery process.
Patients are often afraid to sit in an emergency room for fear of getting sicker. Jubanyik noted that it looks like “patients and visitors are piled on top of each other.” Some days there was no room to accommodate incoming patients, and even after being checked in, they ended up leaving unseen, also known as LWBS. According to the LWBS study, researchers found that LWBS levels above 1% prevented patients with true medical emergencies from receiving needed care.
The effect of emergency room overcrowding on patients is severe and sometimes even fatal. This also poses serious problems for suppliers.
“When you feel you can’t provide the best care to your patients, when everyone on the team is overwhelmed and overwhelmed, [there is] moral distress of having more to do than you can do properly,” Jubanyik said. “People are exhausted. [There is] high turnover. Many nurses left. When the whole place is new, there is no one to teach. There used to be four people working and now there are two.
Jubanyik recommended short-term solutions, but stressed the need for long-term systemic change. She proposed introducing pipeline programs, which would encourage students as early as junior high to consider health professions. She stressed that it is necessary to interest people and diversify the medical staff. According to her, programs like this will take a generation to have an effect, but they are necessary.
“The health system is broken. Many people left. Some hospitals have completely empty floors. [We need to see] where we can get our workforce.
In the short term, Jubanyik said hospitals need to develop spaces where patients can go. There are patients who cannot go home yet but do not need to be hospitalized. Unfortunately, the current system is not designed to pay for adequate home care for many of these patients.
“The system is at risk of crashing,” Jubaynik warned. “Bad things could happen.”
The Yale New Haven Hospital Emergency Room is located at 20 York St.
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