Ten Solutions for Emergency Department Crowding

intrOdUctiOn Over the past decade, emergency department (ED) crowding has occurred and progressed. It has become a major topic of discussion at emergency medicine (EM) conferences, such as those held annually by the Society for Academic Emergency Medicine and the American College of Emergency Physicians. There has been much recent media coverage, such as the Newsweek article, “Code Blue for the ER.”1 Recently the Institute of Medicine published an extensive report on the topic.2 While there is no question that many EDs are crowded, the myriad causes of and solutions to crowding have been widely debated. In our opinion, multiple factors contribute to ED crowding, and the relative contribution of each factor varies between EDs. Circumstances differ between urban and rural hospitals, as well as between county, academic, and private hospitals.3 We believe multiple simultaneous steps are necessary to solve ED crowding. We present 10 putative solutions with commentary on actions at our institution to counter the problem.