Topic:
EMERGENCY MEDICAL SERVICES; HOSPITALS; MEDICAL CARE;
Location:
HOSPITALS;

OLR Research Report


January 7, 2003

 

2003-R-0001

EMERGENCY ROOM STANDARDS

By: Saul Spigel, Chief Analyst

You asked (1) if national standards exist for hospital emergency departments (EDs) space and staffing and (2) for space and staffing comparisons between Bridgeport and Denver, Colorado hospitals.

SUMMARY

We found no United States numerical standards for hospital ED space or staffing requirements. Guidelines from the Australian College for Emergency Medicine say that 7,534 square feet is the minimum size for a functional ED. They call for at least 538 square feet (excluding observation and imaging space) per 1,000 yearly visits.

Federal Medicare rules require EDs in participating hospitals to be supervised by a qualified member of their medical staff and have adequate medical and nursing personnel qualified in emergency care to meet their written emergency procedures and anticipated needs. Guidelines adopted by the American Academy of Emergency Medicine, an organization of emergency room physicians, call for 2.5 patients per physician per hour and 1.25 patients per nurse per hour (or one nurse to three patients at a minimum).

Colorado hospital licensing regulations, while not specifying space and staffing requirements, require EDs to be conveniently located near laboratory and radiological services and separate from surgical and obstetric suites and, at a minimum, contain a reception and control area; public waiting space; and a nurses station. Connecticut has no such specific ED regulations. State regulations simply require each general hospital to provide adequate care at all times for people with acute emergencies.

The ED at St. Vincent Hospital in Bridgeport contains 9,500 square feet: 7,000 square feet in the 21-bed emergency room, 1,500 square feet in a nine-bed observation area, and 1,000 square feet in a four-bed express care suite. The emergency room is staffed at 50 physician hours per day, while the express care suite has 16 physician hours daily. St. Vincent's had 51,037 emergency room visits in FY 1999-00.

The ED at St. Anthony Central Hospital in Denver contains 25 beds in its emergency room, a pediatric trauma room, a dedicated trauma operating suite, and two other designated trauma rooms. It is staffed by 12 full-time emergency medicine physicians and typically has 18 nurses on duty during each 24-hour period.

NATIONAL STANDARDS

We found no U.S. numerical standards for hospital ED space or staffing requirements. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the principal standard-setting body for hospitals. But its hospital accreditation standards are concerned principally with management processes and patient outcomes, not numerical physical or personnel requirements.

Guidelines issued by the Australian College for Emergency Medicine say that 7,534 square feet is the minimum size for a functional ED (including administrative, intake and treatment, and storage areas). They call for at least 538 square feet (excluding observation and imaging space) per 1,000 yearly visits.

If a hospital participates in Medicare, federal regulations require a qualified member of its medical staff to supervise ED services. It must also have adequate medical and nursing personnel qualified in emergency care to meet its written emergency procedures and anticipated needs (42 CFR 482.55). Guidelines adopted by the American Academy of Emergency Medicine, an organization for physicians specializing in this field, call for 2.5 patients per physician per hour and 1.25 patients per nurse per hour (or one nurse to three patients at a minimum). They also call for charge nurses in high volume EDs.

In a 2001, study of emergency department crowding, the American College of Emergency Physicians reported that the “average” ED had an annual patient census of 29,900 and 6,500 square feet of physical space and served a hospital with 214 beds.

COLORADO-CONNECTICUT COMPARISON

State Standards

Colorado. Colorado Department of Public Health and Environment regulations governing licensure of newly constructed or renovated hospitals require them to have a unit and facilities that provide 24-hour emergency treatment. The facilities must be conveniently located with respect to laboratory and radiological services and separate from surgical and obstetric suites and, at a minimum, contain:

● a well-marked entrance separate from the hospital's main entrance, sheltered from weather, and able to service ambulances and pedestrians;

● a reception and control area with visual control of the entrance, waiting room, and treatment area (applicable only to hospitals with 50 or more beds);

● public waiting space with toilet facilities, telephone, and drinking fountain, and stretcher and wheelchair storage;

● an emergency room with clinical sink and hand washing facilities;

● a nurses station (which may be in the reception and control area or the emergency room);

● storage for clean supplies.

In terms of staffing, the regulations require at all hours (1) medical staff coverage and (2) a registered nurse with emergency room training and experience supervising nursing care. Nursing staff must be available to cover average ED use, but the hospital must make provisions for additional nursing staff during unusual circumstances (CO Standards for Hospitals and Health Facilities, ch. IV, 11.1.1 to .10).

Connecticut. Connecticut has no specific regulations governing EDs. It simply requires each general hospital to provide adequate care at all times for people with acute emergencies. In towns with multiple hospitals, mutual agreements can provide for one to operate a 24-hour emergency room while others make arrangements to operate an emergency room twenty-four hours a day with a physician available within 20 minutes of a call (Conn Agency Regs. 19-13-D3(j)).

Bridgeport

Dr. Morton Salomon, chief of the St. Vincent's Medical Center (Bridgeport) ED, estimates that the facility contains 11,000 square feet and 34 beds: 7,000 square feet in the 21-bed emergency room, 3,000 square feet in a nine-bed diagnostic-observation area (where patients stay for up to 23 hours), and 1,000 square feet in a four-bed express care suite. The emergency room is staffed at 50 physician hours per day, while the express care suite has 16 physician hours daily. Nursing director Dawn Martin reports having 188 hours of nursing staff and 80 hours or technical staff per day for the entire facility. Put another way, her total staff (including secretaries) can devote two hours per patient per day. She believes this is below most standards she has seen.

St. Vincent's had 51,037 emergency room visits in FY 1999-00, according to the Office of Health Care Access.

Denver

Denver's population was approximately 555,000 in 2000. St. Anthony Central Hospital is one of 12 Denver hospitals with an ED. Aurie Barry, interim ED director, stated that the ED handles 130 to 150 patients a day. This translates into between 47,450 and 54,750 patients a year, roughly the volume that St. Vincent's handles. It cares for the largest number of adult trauma cases in Colorado.

The ED contains 25 beds, a pediatric trauma room, a dedicated trauma operating suite, and two other designated trauma rooms. Barry was not sure of its physical size. She said it is staffed by 12 full-time emergency medicine physicians, typically has 18 registered nurses on duty during each 24-hour period, and has a radiologist and critical care technician on duty at all times. In addition, a surgeon, anesthesiologist, and radiology and CAT scan technicians are available at all times for ED patients who need surgery.

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