Issues You Should Know

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Access to Emergency Care

  • Emergency department visits in 2009 rose to 136 million, up from 96.5 million in 1995.  At the same time, the number of emergency departments decreased by 9 percent resulting in dramatic increases in patient volumes and waiting times at the remaining facilities.
  • U.S. hospitals over the past 10 years closed more than 100,000 inpatient beds and nearly 8,000 intensive care beds in an effort to control costs. The majority of the nation’s 4,600 hospital emergency departments report that they are operating “at” or “over” critical capacity.
  • Overcrowded emergency departments threaten access to emergency care for everyone – insured and uninsured.
  • Effective solutions require a national commitment and recognition that emergency medicine is an essential community service that must be funded. This crisis can only be solved by a concerted effort by hospitals, policymakers, community leaders and health plan payers.
  • Adequate monitoring and data collection is needed to further define the problem and target effective solutions. The American College of Emergency Physicians advocates for fair compensation for all healthcare services, including those mandated by the federal government, and measures to limit the practice of emergency department “boarding.”

On-Call Physician Shortage

  • Emergency physicians and hospital medical staff have shared responsibilities to provide medical screening exams and stabilize the emergency conditions of patients who come to emergency departments.
  • While emergency physicians are available 24 hours a day, 7 days a week, other medical specialists are "on-call," which means they are called in as needed. On-call physicians, such as neurosurgeons, cardiologists, and orthopedists, provide services to hospital emergency departments to medically screen and stabilize emergency conditions.
  • Every day in the United States, nearly 300,000 patients request care from emergency departments. Many have serious illnesses or injuries that require consultation with medical specialists, hospitalization, or surgical intervention.
  • An increasing number of on-call physicians are not available to come to the emergency department because medical liability insurance is not available or inadequate reimbursement.
  • A growing shortage of these medical specialists is contributing to the nation's overcrowding crisis and longer waiting times in emergency departments.
  • The American College of Emergency Physicians is working with other medical specialty organizations, including the American Medical Association and the American Hospital Association, to ensure that emergency patients continue to have access to the care they need.


  • Annual visits to emergency departments nationwide jumped to a record high of 136 million in 2009 — up from 115 million in 2005 — with an average of 227 visits per minute, according to statistics released by the Centers for Disease Control and Prevention (CDC).
  • Hospital emergency departments, also known as emergency rooms or “ERs,” provide lifesaving care, 24 hours a day, seven days a week. Emergency departments are staffed by doctors and nurses with special training and skills in emergency care.
  • Some emergency departments today are overcrowded with patients who may wait hours to be treated. More than 1,000 emergency departments have closed in the past decade. At the same time, the number of emergency department visits has increased to 136 million.
  • Hospital emergency departments are the only place in the health care system where people can go for medical help any time of the day or night. No one can be turned away; it’s the law.
  • Very sick patients often need to be admitted to the hospital, but if no beds are available, they have to wait in the emergency department until one opens up. This practice is known as “boarding.” It can back up the emergency department and cause other patients to wait even longer for care. Boarding also may cause the hospital to divert ambulances to less crowded emergency departments.

Why Some People are Seen Sooner Than Others

  • When you first arrive in the emergency department, a triage nurse will see you first. The nurse will ask you questions about your health problem and may take your temperature and check your blood pressure and pulse.
  • This process, called triage, will determine whether you need to see a doctor immediately. Even though you may have arrived before another patient, if another patient is sicker, the doctor will take care of him or her first. If you are asked to wait and start to feel worse or have pain, tell the triage nurse right away.

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