Overcrowded ER Points to Larger Problems

California hospitals in areas with large minority populations are disproportionately affected by emergency room overcrowding, making them more likely to ease the congestion by diverting ambulances to other hospitals, according to a UCSF-led study.

The study, which looked at 2007 data from 202 hospitals around the state, found hospitals that served the greatest percentage of minority patients turned away ambulances because of overcrowding as much as four times as often as those that served the smallest number of minorities.

Health experts say ambulance diversion, the practice of turning ambulances away temporarily when a hospital’s emergency department becomes overcrowded, can lead to delayed care and poorer health outcomes.

What this study points to is that overcrowding is a symptom of larger problems within the health care system, the study’s author said. These include patients who lack primary-care services that could keep them out of the hospital, and hospitals that are overwhelmed by poorer patients or could use better emergency management. These issues can be particularly acute in areas with higher minority populations.

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Emergency departments become overcrowded for several reasons. Patients — often those who are uninsured or lack adequate access to primary-care services — end up there for nonurgent care or for serious conditions that could have been treated earlier or even prevented.

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Jan Emerson-Shea, spokeswoman for the California Hospital Association, said communities with high numbers of minorities tend to have more people who are uninsured, are on Medi-Cal or otherwise lack access to care.

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