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Emergency Department Overcrowding and Children

Hostetler, Mark A. MD, MPH; Mace, Sharon MD; Brown, Kathleen MD; Finkler, Joseph MD; Hernandez, Dennis MD; Krug, Steven E. MD; Schamban, Neil MD

doi: 10.1097/01.pec.0000280518.36408.74
Review Article

Emergency department (ED) overcrowding has been a serious issue on the national agenda for the past 2 decades and is rapidly becoming an increasingly significant problem for children. The goal of this report is to focus on the issues of overcrowding that directly impact children. Our findings reveal that although overcrowding seems to affect children in ways similar to those of adults, there are several important ways in which they differ. Recent reports document that more than 90% of academic emergency medicine EDs are overcrowded. Although inner-city, urban, and university hospitals have historically been the first to feel the brunt of overcrowding, community and suburban EDs are now also being affected. The overwhelming majority of children (92%) are seen in general community EDs, with only a minority (less than 10%) treated in dedicated pediatric EDs. With the exception of patients older than 65 years, children have higher visit rates than any other age group. Children may be at particularly increased risk for medical errors because of their inherent variability in size and the need for age-specific and weight-based dosing. We strongly recommend that pediatric issues be actively included in all future aspects of research and policy planning issues related to ED overcrowding. These include the development of triage protocols, clinical guidelines, research proposals, and computerized data monitoring systems.

Department of Pediatrics, Section of Emergency Medicine, The University of Chicago, IL.

On behalf of the Subcommittee on Emergency Department Overcrowding and Children, Section of Pediatric Emergency Medicine, American College of Emergency Physicians.

Address correspondence and reprint requests to Mark A. Hostetler, MD, MPH, The University of Chicago Children's Hospital, 5841 S. Maryland Ave, MC-0810, Chicago, IL 60637. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.