Hospital emergency departments: the authors respond.

In response to a perceived crisis in California's emergency department (ED) capacity, Glenn Melnick and colleagues sought to construct an empirical database that could bring objective data to bear on this important issue. In this response they address some of the substantive issues raised by the authors of four preceding commentaries. These issues include the use of aggregates and averages, the omission of trauma centers, staffing shortages, and overcrowding. In their view, the paper has added reliable new information to better understand the underlying economics faced by community hospitals with EDs and how they have responded over the past decade.