When hospital overcrowding occurs, it creates a bottleneck for patients seeking help, and it has been shown to contribute to delays in diagnosis and treatment. The consequences of overcrowding are far-reaching, with patient safety, satisfaction and health care outcomes all suffering.

In the past, the majority of hospital admissions were scheduled inpatient procedures, but over the years those procedures shifted to ambulatory settings and hospitals have been forced to close and consolidate, creating tight bed availability. The result is that overcrowding has become a national problem, and it affects both EDs and other departments, including surgical units.

There are many reasons for hospital overcrowding. ED staff often focus on the need to reduce door-to-needle time, which is the time from when a patient is screened in the ED until they receive their medication, but other factors that impact the entire flow of patient care are also significant. The cost of building a new hospital bed is prohibitively high, and attempts to add beds within a hospital must run through a gauntlet of lengthy state reviews.

Changing hospital operations to address overcrowding is important, but it can only go so far. Like the parable of the elephant, where everyone looks at a different part of the animal, when it comes to addressing overcrowding, each institution has to work on its own part of the system. This includes EDs, but it should also include other departments and community-based services. The use of observation units, for example, can be an effective link between microlevel and macrolevel interventions, and they have been shown to improve ED and inpatient bed utilization.