What happens when a hospital is full?

The United States has more than 5,200 hospitals with nearly 800,000 fully-staffed beds. Yet, certain hospitals struggle to keep up with the demands of their communities. It is not uncommon for hospitals or an emergency room to become full and for prospective patients to experience long waits in certain situations. Murray Côté, PhD, associate professor at the Texas A&M School of Public Health, explains what happens when a hospital runs out of room—and what that means for a patient.

Diversions: When a hospital reaches capacity

“Approximately half of all hospital admissions will be elective. In other words, elective patients come in through scheduled medical or surgical admissions or are transferred from another facility,” Côté said.

Hospital administrators can plan for elective admissions, but they cannot plan for those that come in through the emergency room. However, administrators estimate that 9 percent or more of emergency room visits will result in hospital admissions.

A hospital with a full surgery schedule and a busy emergency room can cause these departments to compete for available rooms. This can lead to overcrowding in the emergency room.

In a disaster situation when the emergency room becomes overcrowded and many patients require admission, most hospitals activate what is called a surge plan. The surge plan brings together necessary resources like staffing and equipment to ensure the entire hospital works together to assign beds in the most efficient manner.

“If a hospital does run low on beds, then it can choose to temporarily divert patients elsewhere who need care,” Côté explained. “However, a diversion does not mean the hospital will completely stop accepting new patients in an emergency. In fact, diversion is often the last resort for hospitals.”

Diversion is also only done when it is safe to send the patient elsewhere and they are stable enough to make the journey.

“If a patient walks into the hospital with an emergency, regardless the situation, then the hospital will absolutely do what they can to help,” Côté explained. “Patients should never worry about being denied care or sent somewhere else in a true emergency.”

Hospital capacity in rural settings

Diversion is more common in urban cities where hospitals are in close proximity to each other. In the case of a rural hospital, a diversion may not be possible. People in rural communities may live several towns away from the closest hospital, so diverting an ambulance 40 minutes to the second-closest hospital is not necessarily an option. This poses a challenge because rural hospitals often have fewer beds and resources in comparison to their urban counterparts.

Ideally, hospitals want the right care for the right patient at the right time. However, in situations with limited resources, accomplishing that can be a challenge. “If hospitals do not have the resources to admit additional patients and they cannot divert them elsewhere, then they have complex protocols and strategies they enact,” Côté said.

Whether in a rural or urban area, facility planners see no perfect answer for how big a hospital needs to be to sustain the community. However, “rural settings make that decision even more complicated, because they do not have much opportunity for specialized care,” Côté said, “The decision about what goes in the hospital and how large it needs to be should be made on what the community generally needs most of the time.” If more specialized care is required, then hospitals will often stabilize those patients in their emergency rooms. After they are safe to transport, then they will transfer them to a location with a greater amount of specialized resources.

The role of freestanding emergency rooms

A growing trend, especially in the state of Texas, are the freestanding emergency departments—an emergency room physically separated from a hospital. Unlike urgent care clinics, the free-standing emergency rooms have diagnostic and laboratory facilities capable of treating most emergency medical conditions. Emergency physicians also fully staff the freestanding emergency departments.

“The 24-hour clinics and freestanding emergency rooms build in more capacity to the community’s health care infrastructure,” said Côté, “However, the challenge is making patients aware of the different types of resources and the appropriate level of care the patients may need. Because emergency rooms are more expensive to operate, patients may often receive a large bill when a less expensive urgent care visit may have been more appropriate.”

As a general rule of thumb, an urgent care center can treat the same things as a primary care doctor’s office and should be used after hours or on weekends for minor medical issues. However, they may not be open 24/7 and they may not have comprehensive laboratory and imaging equipment.

Emergency rooms, whether freestanding or attached to a hospital, should be reserved for real emergencies. Some examples are major injuries or serious warning signs of a heart attack or stroke. Both emergency rooms and urgent care clinics may have helpful clinical guidelines posted or available to the public via their website to help patients self-select what level of care is right for them.

What to do in an emergency

In a true emergency, call 9-1-1 and dispatch will tell you what to do—whether wait for an ambulance or head to the closest emergency room. “Regardless if the hospital is full or on diversion, you will receive care during a true emergency,” said Côté. “Otherwise, listen to your emergency care providers and they will instruct you on where best to receive care at that time.”