For some time now, we've been hearing about problems in the nation's emergency departments, but the issue became all too real this week when a woman died of a heart attack after waiting two hours to be treated [1]. It's very likely that her death could have been avoided had she been treated promptly. And since her death, some doctors have noted that it was only a matter of time until ER overcrowding caught up with healthcare providers.

The less-than-ideal situation in emergency departments is the result of a number of factors: there are fewer people with insurance due to high premium costs, a greater number of immigrants, homeless and indigent patients are using the ER, and the aging baby boomer population requires more care. Most of these factors are beyond a hospital's immediate control, and in the long term, all must be addressed. However, many hospitals have taken steps to do what they can to reduce wait times and/or ease overcrowding of ERs.

• A two-year program at the Duke Clinical Research Institute aims to coordinate emergency care from medical workers, hospitals and doctors to better manage heart attack patients [2]. As a result of the program, many hospitals have reduced the time it takes for patients to receive an angioplasty to just 90 minutes.
• Fifteen Florida-based HCA hospitals instituted a program to re-direct non-emergency patients [3] to nearby clinics instead of treating them in the ER.
• A University of Chicago Hospitals program educates patients about their options for follow-up treatment [4] after receiving care in the ER. This helps patients find a "medical home" where future visits can be handled.
• A number of hospitals are investing in pediatric emergency rooms [5] that separate children from adult emergency patients. This allows healthcare providers to focus on the special needs of pediatric patients, while at the same time, taking pressure off of the regular ER.

There are numerous other examples of hospitals doing what they can to manage ER overcrowding. All of these measures point to the fact that emergency departments are becoming increasingly selective in who they'll treat and how they'll treat them. And that's not a bad thing. Refining the guidelines of who's admitted to the ER relieves pressure on overworked staff and allows patients to receive faster care elsewhere. It also saves a lot of money that can then be re-invested into the system. Having processes in place to handle special cases--such as cardiac disease--helps healthcare providers administer faster, better care. Hospitals may have to wait a long time before the underlying problems that cause ER overcrowding are solved, but taking action now to improve emergency processes could save a lot of lives in the meantime. -Maureen [6]