Emergency Department under Missile Strikes: Emphasizing the Intrinsic Factors for Overcrowding

Abstract

Introduction: For a period of 30 days between July and August 2006, the Emergency Department (ED) at Rambam Medical Center functioned under missile attacks. Two thirds of the beds were set aside for injured people, leaving only one third of the beds for other patients. Despite this abrupt 66% decrease in the number of beds, and a decrease of only one third in the number of regular visits, our ED was far from being overcrowded during that period of time. Objectives: To describe the functioning of our ED under fire, thus gaining new insights on ED overcrowding from a unique perspective that is difficult to artificially create. Results: There was a 36% decrease in the number of visits to our ED. There was also a 43% decrease in the hospital’s bed occupancy rate. There was a statistically significant decrease in the visits of the elderly population (>70 years of age) to the ED, but no decrease was seen in the younger population. The mean evaluation time during this period, decreased from 2.8 to 2.4 hrs (not significant), but the average total length of stay decreased significantly (from 6.4 to 2.7 hours). Despite doubling the occupancy rate for each functioning bed, our ED was far from overcrowded. Conclusions: The availability of physicians, laboratory and imaging services and many empty beds in the hospital (intrinsic factors), are more crucial in preventing ED overcrowding than decreasing the number of non-urgent visits to the ED (extrinsic factors).