Table 1.

Factors affecting crowding

Factors within the hospital	Outside factors affecting the hospital
Increased hospital occupancy	Inadequate access of the general population to primary care and specialists as an outpatient
Increasing patient acuity	Ambulance and EMS design
Inappropriate patient referral	Expectations of the general public of health care delivery and the role of health care providers and institutions (outpatient and hospital)
Inadequate out-of-hours service	Demographics with an aging population
Inappropriate triage	Percentage of illegal immigrants with no access to structured outpatient health care
Inexperienced medical staff	Social reasons (no transportation, prevalence of homelessness, prison population, nursing homes)
Staff shortages	Insurance practices like Health Maintenance Organization (HMO) practices of public insurers
Delayed ancillary services (resulting in increased administrative burden to medical staff)	Influence of media and internet on patients behavior in accessing emergency care and sense of individual entitlement