Jun 29, 2026 · 26 min · 9 segments
Emergency department overcrowding has become one of healthcare's most pressing operational challenges, yet many organizations continue to focus on symptoms rather than underlying causes. As patient…
Marty LucentiGuest
Daniel MarinoHost
When, you know, working with organizations around the country, what are you seeing as the big challenge or maybe the big drivers related to overcrowding in emergency departments?
I think the starting point when you start to look at overcrowding in the emergency room, it's really important to start with, what do you see emerge as the patterns of utilization in the emergency room? What does the emergency room of today provide for the health system? And quite honestly, when you take a look at what the emergency room does now, I like to refer to it as the emergency room has slowly and predominantly transformed itself into an acute diagnostic center.
And because much of the original physical footprints were originally designed with the primary concept of an emergency room, this is where you go when you have a life-threatening emergency.
But when you actually look at the populations that actually present to the emergency room The emergency rooms forms a much broader set of services for the health system.
When you look at the populations within an emergency room, there is that group that has a life-threatening injury or illness, but that only represents about 25 to 30% of the ER visits.
There's another 25% that are relatively low acuity, but that low acuity often requires some uniqueness of scope of practice.
You know, the misperceptions about low acuity emergency room visits is, They could have gone to an urgent care.
They could have gone to a primary care when oftentimes even the low acuity visits in the emergency room were actually referred over by urgent cares or family practice or primary care providers just because of scope of practice.
do incision drains, not comfortable doing some light sedation on a child to do suture repairs and so forth.
But the area that has become the dominant center of massive patient care in the emergency room is actually this complex patient population.
Patients who have either medical complexity, have a lot of comorbidity issues, or have a complicated problem.
They're not acutely decompensating, they're not in the process of dying, but they're getting sicker, and in order to really fully evaluate them, There's a lot of diagnostics and potentially a series of different scopes of practice, specialty perspectives that need to be interjected.
So it's an interesting constellation of presentations that come to the emergency room.
The other part to look at, Dan, is the single greatest predictor of an overcrowded emergency room is a full hospital.
I mean, a lot of times, you know, when the census in the hospital is, you know, above 90%, you know, then all of a sudden the hospital's scrambling and maybe, you know, they're discharging and, transitioning the patient out only to come to find out that maybe the post-follow-up, post-discharge transitions care, really those protocols aren't in place or the processes aren't in place as strong as they should be.
When, you know, working with organizations around the country, what are you seeing as the big challenge or maybe the big drivers related to overcrowding in emergency departments?
I think the starting point when you start to look at overcrowding in the emergency room, it's really important to start with, what do you see emerge as the patterns of utilization in the emergency room? What does the emergency room of today provide for the health system? And quite honestly, when you take a look at what the emergency room does now, I like to refer to it as the emergency room has slowly and predominantly transformed itself into an acute diagnostic center.
And because much of the original physical footprints were originally designed with the primary concept of an emergency room, this is where you go when you have a life-threatening emergency.
But when you actually look at the populations that actually present to the emergency room The emergency rooms forms a much broader set of services for the health system.
When you look at the populations within an emergency room, there is that group that has a life-threatening injury or illness, but that only represents about 25 to 30% of the ER visits.
There's another 25% that are relatively low acuity, but that low acuity often requires some uniqueness of scope of practice.
You know, the misperceptions about low acuity emergency room visits is, They could have gone to an urgent care.
They could have gone to a primary care when oftentimes even the low acuity visits in the emergency room were actually referred over by urgent cares or family practice or primary care providers just because of scope of practice.
do incision drains, not comfortable doing some light sedation on a child to do suture repairs and so forth.
But the area that has become the dominant center of massive patient care in the emergency room is actually this complex patient population.
Patients who have either medical complexity, have a lot of comorbidity issues, or have a complicated problem.
They're not acutely decompensating, they're not in the process of dying, but they're getting sicker, and in order to really fully evaluate them, There's a lot of diagnostics and potentially a series of different scopes of practice, specialty perspectives that need to be interjected.
So it's an interesting constellation of presentations that come to the emergency room.
The other part to look at, Dan, is the single greatest predictor of an overcrowded emergency room is a full hospital.
I mean, a lot of times, you know, when the census in the hospital is, you know, above 90%, you know, then all of a sudden the hospital's scrambling and maybe, you know, they're discharging and, transitioning the patient out only to come to find out that maybe the post-follow-up, post-discharge transitions care, really those protocols aren't in place or the processes aren't in place as strong as they should be.
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