When the Lifeboats Are Full: The Human Cost of ER Overcrowding

I was a third-year resident doctor specializing in Emergency Medicine when I took care of a man who had drowned in his pool. It was 4pm on a Saturday in a busy Emergency Department in Queens, and the patient was brought to us by ambulance and in cardiac arrest. We attempted to resuscitate him for well over an hour, compressing his heart, mechanically ventilating his lungs, cutting into his chest to release trapped air, and placing large sterile tubes in his veins to give him blood. Despite our best efforts, he passed.  

I stepped out of the resuscitation bay where that man died, and I wrote down the tasks that I had to do. During the time I spent in the resuscitation, I was assigned 4 more patients who I had to see. I also had to call the hospitalist physician to get two other patients admitted to beds upstairs, repair a hand laceration, prescribe antibiotics for a young lady with a salivary gland infection, call the social worker to help organize a Medicaid van to get another patient home, compassionately deliver the news of death to the family of the man who had just passed, register the death, and call the medical examiner’s office. I had to move as fast as I could. If I fell behind, patients with potentially time sensitive conditions such as heart attacks or strokes would wait longer. The longer these patients were left without treatment, the more likely they were to develop serious complications and die.    

The circumstance I experienced is dangerous for patients and unsustainable for providers, and similar events happen in New York City Emergency Departments all the time, every day. The problem can be stated plainly. There are not enough people working in NYC Emergency Departments and there is not enough room in NYC Emergency Departments. The result of this is that more patients die, more patients have irreversible complications of their disease, patients wait longer, and patients have horrible experiences when they go to the Emergency Room.

The solution to this problem is also plainly stated. You need to spend more money on your Emergency Departments. You need to hire more doctors and nurses to staff emergency rooms. You need more equipment and ancillary staff like radiology technicians and social workers. You need to expand the physical size of current Emergency Departments or open new ones. The only way to avoid circumstances like the one I went through is to have more healthcare providers working in parallel, such that the patient load per doctor does not exceed what is safe and reasonable.

This idea is demonstrated in other parts of the country. A colleague of mine took a job in Sacramento, CA. At her hospital, Emergency Department physicians are only allowed to be assigned 12 patients during an 8-hour shift. The result is that she can deliver high quality and compassionate care to her patients. Her situation differs markedly from that in NYC, where Emergency Department Physicians are expected to see 2-4 patients per hour and with no limit on the total number of patients they can be assigned over their shift. It is easy to see why the Emergency Room experience for patients in NYC is, on average, terrible.

We can afford to do better. If we hire more Emergency Department doctors and staff and build more space where patients can be seen, we will empower healthcare workers throughout the city to deliver excellent care and save lives.