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Lisa Black

Primary aims of the recommendations are improving the quality of care, patient safety, patient experience, and the health of populations, as well as reducing the per capita cost of health care.

Itasca, IL --Emergency departments have experienced crowding, long waits for care and hospital bed shortages this winter due in part to a “tripledemic” surge of influenza, respiratory syncytial virus and COVID-19, as well as a response to rapidly rising mental health care needs of children and teens.

Yet even before 2022, the number of pediatric patients seeking care in emergency departments had been rising, with research showing that 80% of pediatric emergency department visits occur in a non-children’s hospital.

The American Academy of Pediatrics concludes that reducing crowding in emergency departments will require a coordinated effort across the health care delivery system. The Academy’s recommendations are in a new policy statement, “Crowding in the Emergency Department: Challenges and Recommendations for the Care of Children.” The statement and an accompanying technical report will be published in the March 2023 Pediatrics (published online Feb. 20).

“Emergency departments serve as a safety net for health care in many communities,” said Toni K. Gross, MD, MPH, FAAP, lead author of the policy statement. “They need to be readily available to provide emergency care not only on a regular basis but in cases of disasters or pandemics. This requires a careful, coordinated effort on the part of health care systems to improve the flow and care of patients. It also requires helping more young patients access care for chronic conditions in a clinic or other outpatient setting, rather than the emergency department.”

The AAP Committee on Pediatric Emergency Medicine, which developed the policy statement, noted that the primary concern is patient safety. Boarding, or holding an admitted patient in the emergency department -- typically due to a lack of available staffed inpatient beds --is believed to be one of the primary contributors to crowding.

The AAP recommendations include:

  • Integrating mental health care into primary care pediatrics, including strategies and models for payment.
  • Supporting accessible outpatient resources for seeking care, including unscheduled visits and access to subspecialty care.
  • Advocating for incentives for extended or non-traditional hours of outpatient service (including weekends), and unique efforts to coordinate care, such as school and community-based programs.
  • Extending access to medical care through telemedicine services.
  • Encouraging and assisting families with enrollment for health care coverage and advocating to reduce barriers to enrollment in health care coverage.

“There is really no single approach to avoid crowding in the emergency department,” Dr. Gross said. “There are steps hospitals and health care systems can take to reduce crowding. It’s also ideal to help families avoid emergency department visits by making it easier for them to access preventive care and manage chronic conditions, including mental health disorders, at an outpatient office.”

To request an embargoed copy of the policy statement and technical report or an interview with an expert, contact AAP Public Affairs.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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