Emergency Department Crowding, Part 2-Barriers to Reform and Strategies to Overcome Them

Part 1 of this 2-article series reviews serious moral problems created by emergency department (ED) crowding. In this second part of the series, we identify and describe operational and financial barriers to resolving the crisis of ED crowding, along with a variety of institutional and public policy strategies proposed or implemented to overcome those barriers. Finally, the article evaluates 2 additional actions designed to address the problem of ED crowding, namely, distribution of a warning statement to ED patients and implementation of a reverse triage system for safe early discharge of hospital inpatients. [Ann Emerg Med. 2009;53:612-617.]