Nursing is a harmonious blend of art and science. Unfortunately, the process of art and science can be prolonged whether intended or not. Dr. Howard Markel (2013), reflects on one of the most groundbreaking discoveries that “changed the course of modern medicine” in a monthly column for the PBC NewsHour. In September of 1928, a bacteriologist, Alexander Fleming, returned to what appeared to be a messy lab but actually included one great, accidental finding. Fleming discovered penicillin when he returned from a vacation back to his laboratory in London. He found mold growing on petri-dishes that had been exposed to Staphylococcus aureus with no evidence of S. aureus colony growths. Upon further examination, Fleming found that the mold, or rather
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To put it simply, crowding in the ED occurs “when demand for services outstrips available resources” (Hwang, 2011, p 528). The resources in EDs may include health care providers, such as physicians, nurses, respiratory therapist, available beds, and other medical supplies. However, like any facility, the resources in an emergency department are limited due to space, finances, and regulations. Expecting the ED to provide care to everyone, 24/7 is unreasonable as it places an enormous burden and responsibility upon only one unit of a hospital. The use of ED increased by 11 percent in the United States from 1997 through 2007, bringing the year of 2007 to approximately 117 million ED visits, including approximately 8 percent of those visits classified as non-urgent (U.S. Government Accountability Office, 2011). Despite the numerous studies that have been published on crowding, the term, “overcrowding in the ED,” lacks a common definition or measure (Hwang, 2011). Overcrowding in the ED has been associated with a variety of different measurements. Overcrowding may be measured by physicians feeling rushed, clinician opinion of crowding, waiting times, available beds, and the number of arrivals. Aside from the number of arrivals, there are further subgroups of the patients as far as the number of patients within each phase of the ED process including patients in waiting room, registered, awaiting triage, low-complexity patients, number of patients at each acuity level, and the number of patients that leave without being seen (Hwang, 2011). In a systematic review of measurements of crowding in the emergency department, seventy-one unique measures of ED crowding were identified in medical literature, with the most common measures including the ED census, being the total number of patients in the ED, ED occupancy rate, and ED LOS (Hwang, 2011).
To put it simply, crowding in the ED occurs “when demand for services outstrips available resources” (Hwang, 2011, p 528). The resources in EDs may include health care providers, such as physicians, nurses, respiratory therapist, available beds, and other medical supplies. However, like any facility, the resources in an emergency department are limited due to space, finances, and regulations. Expecting the ED to provide care to everyone, 24/7 is unreasonable as it places an enormous burden and responsibility upon only one unit of a hospital. The use of ED increased by 11 percent in the United States from 1997 through 2007, bringing the year of 2007 to approximately 117 million ED visits, including approximately 8 percent of those visits classified as non-urgent (U.S. Government Accountability Office, 2011). Despite the numerous studies that have been published on crowding, the term, “overcrowding in the ED,” lacks a common definition or measure (Hwang, 2011). Overcrowding in the ED has been associated with a variety of different measurements. Overcrowding may be measured by physicians feeling rushed, clinician opinion of crowding, waiting times, available beds, and the number of arrivals. Aside from the number of arrivals, there are further subgroups of the patients as far as the number of patients within each phase of the ED process including patients in waiting room, registered, awaiting triage, low-complexity patients, number of patients at each acuity level, and the number of patients that leave without being seen (Hwang, 2011). In a systematic review of measurements of crowding in the emergency department, seventy-one unique measures of ED crowding were identified in medical literature, with the most common measures including the ED census, being the total number of patients in the ED, ED occupancy rate, and ED LOS (Hwang, 2011).