ABSTRACT
Over the past 30 years, hospital-based emergency departments (EDs) have evolved to provide not only acutecareservicesforthecriticallyill,butahostofservices:safetynetcareforindigentpatients,publichealthsurveillance,disasterpreparedness,observationandproceduralcare,occupationalservices, employeehealth,and,inmanycases,primaryhealthcare(InstituteofMedicine,2006).Despitethis expansionofservices,EDshaveseentheirresourcesdeclinerelativetothesedemands.Ÿeoverall numberofEDbeds,inpatientbeds,andtotalnumberofU.S.hospitalshasdecreasedconsiderablyin thelast20years(Nawaretal.,2007).AccordingtotheInstituteofMedicine,thisincreaseindemand andreductionincapacityhasledtoanationalcrisisofEDcrowding(InstituteofMedicine,2006).ED crowdingresultswhenthedemandforservicesexceedsresources(eitherpersonnelorcapacity),and patients experience long waits for those services.
