NCPA - National Center for Policy Analysis

Emergency Room Shutdowns

December 19, 2000

A number of cities, including San Francisco, Denver and Phoenix, have had to hang "no vacancy" signs out for ambulance crews because their emergency rooms were closed. Massachusetts General, considered one of the country's best hospitals, has been "on diversion" for about 45 hours a week this year, and on average two of Boston's emergency rooms close to ambulances at some point every day.

A survey this year of more than 60 emergency department directors by the Massachusetts College of Emergency Physicians found more than 80 percent of them had been forced to divert ambulances, and about 38 percent said they had seen "adverse outcomes" as a result of crowding.

According to one doctor, "We've got an epidemic of the non-availability of acute care beds and the epidemic is becoming a pandemic."

The problem, say observers, extends to more than just crowded emergency rooms.

  • There is crowding of acute-care hospital beds in general, leaving patients in the emergency room because there are no beds in intensive care or critical care units, causing the system to gridlock.
  • Managed care has failed to live up to its promise to keep people out of the emergency room.
  • And many uninsured people end up in emergency rooms for lack of primary care.
  • Federal cuts in reimbursement for Medicare and Medicaid have brought added hospital cuts.

An article in January's Annals of Emergency Medicine warned "unless the problem is solved, the general public may no longer be able to rely on emergency departments for quality and timely emergency care, placing the people of this country at risk."

Source: Carey Goldberg, "Emergency Crews Worry as Hospitals Say, 'No Vacancy,'" New York Times, December 17, 2000.


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