Emergency department crowding, part 1--concept, causes, and moral consequences

Area of Science:

• Medical Ethics
• Health Policy Analysis
• Emergency Medicine

Background:

• Emergency departments (EDs) globally face increasing crowding.
• This situation presents significant ethical and policy challenges.
• Distinguishing between 'crowding' and 'overcrowding' is crucial for accurate analysis.

Purpose of the Study:

• To provide an ethical and policy analysis of emergency department crowding.
• To define, measure, and identify the causes of ED crowding.
• To explore the adverse moral consequences of ED crowding.

Main Methods:

• Conceptual analysis of terminology related to ED crowding.
• Identification and discussion of root causes, particularly patient boarding.
• Description of ethical implications and adverse outcomes for patients and care.

Main Results:

• The term 'crowding' is preferred over 'overcrowding' for precise definition.
• A primary cause of ED crowding is the inability to admit patients to inpatient beds, leading to patient boarding.
• Adverse consequences include increased patient harm, care delays, privacy breaches, communication issues, and reduced access to care.

Conclusions:

• ED crowding is a complex issue with profound ethical dimensions.
• Patient boarding is a key driver of ED crowding.
• The identified adverse consequences highlight the urgent need for policy interventions.