An Overcrowded ER Can Still Treat Cardiac Patients Efficiently

Understandably, hospital Emergency Rooms (ERs) don’t have a constant flow of patients, so there are times of over- and under-crowding.  And it’s natural to wonder whether serious conditions may be overlooked or urgent treatment delayed when ER capacity is strained.  A study reported in the Annals of Emergency Medicine shows that in one hospital, at least, heart attack patients are treated quickly and effectively, whether the ER is crowded or not.

The suburban hospital in the study was Advocate Christ Medical Center in Oak Lawn, Illinois. All patients arriving at the ER with an acute myocardial infarction (i.e. a heart attack) treated by emergency angioplasty were analyzed over a 2-year period. There w ere 210 of them.  Time between ER arrival and angioplasty was measured for each patient (“door-to-balloon time”); the target time was less than 90 minutes, and in fact the average for these patients was 65 minutes.  The ER occupancy rate was also measured on arrival for each patient;  it ranged from 28% full to 214% of full capacity, with an average for these patients of 127%.     

Analyses showed that the door-to-balloon times didn’t significantly change with increasing occupancy of the ER.  The only relevant (statistically significant) delay in door-to-balloon times was associated with the availability of the catheterization laboratory within the hospital.

This is a somewhat reassuring study.  However, it must be realized that this was one hospital only, and that the measure chosen – heart attack requiring catheterization –was only one of those conditions that present at the ER requiring urgent treatment; moreover, the door-to-balloon time is a measure that has attracted much attention in recent years, and this may have influenced the results. 

Our ERs in the USA are often overcrowded, and this is likely to become more frequent in the future – some ERs are closing, others are having finance-related staffing restrictions.  Hopefully these problems can be overcome, with attention also paid to other important emergencies, such as stroke.