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Acad Emerg Med. 2011 Dec;18(12):1255-61. doi: 10.1111/j.1553-2712.2011.01225.x.

System dynamics and dysfunctionalities: levers for overcoming emergency department overcrowding.

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Brigham and Women's Hospital Center for Patient Safety Research and Practice, Division of General Medicine/Primary Care Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.


Overcrowding of U.S. emergency departments (EDs) is a widely recognized and growing problem. This presentation offers the perspectives of a primary care physician (PCP) examining the problem at three levels: global health policy, quality process improvement, and more intimate clinical caring. It posits that ED overcrowding is actually a symptom of 10 more fundamental problems in U.S. health care and EDs: variations/supply-demand mismatch; primary care provider shortfalls; limited after-hours access; admission throughput challenges; clinical challenges related to discontinuity patients; clinical challenges related to those with special needs; interruptions; testing logistical challenges; suboptimal information systems; and fragmented/dysfunctional health insurance system, leaving many un- and underinsured.

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