Visit a hospital emergency room in some Massachusetts cities, and it can seem like an extended stay in purgatory.

That might change if legislation proposed by state Sen. James Timilty, D-Walpole, is successful. The legislation would require new guidelines for inpatient admissions for emergency patients.

Patients entering the emergency room who need to be admitted to the hospital for further treatment would be admitted within a set time frame, under the legislation. Emergency departments that comply with the new guidelines by December 2008 would receive financial rewards.

The bill also establishes an advisory council on hospital and emergency room crowding.

Dr. Bruce Auerbach, head of Attleboro's Sturdy Memorial Hospital emergency department, said emergency room overcrowding is an issue across the nation, but said Sturdy is not having problems. "At Sturdy we have been able to work cooperatively and collaboratively with all the sections," he said. "We don't have patients who are boarding for hours and hours and hours."

He said the hospital has put systems and policies in place to keep patients moving efficiently, so they get where they need to be as quickly as possible.

"But every institution in the commonwealth does not enjoy this," Auerbach said.

Some of the state's more crowded areas do have emergency room crowding, but Auerbach said there are two ways to look at the problem.

"There are those who believe this is a problem with people who overuse emergency departments because they don't have access to primary care - that's an inflow problem," he said. "We see it as an outflow problem."

Auerbach said the problem comes not because too many people are going to the emergency room, but because they don't have anywhere to go afterward.

"If you have someone come in with a sprained ankle, they can get treated and the doctor can call the orthopedic surgeon if need be, and the patient is discharged with their splint and their crutches. They are discharged," he said. "But someone who is really sick, who comes in with congenital heart failure, they need to be admitted. They need to stay in the bed until something opens up and they can move on. That's where the backup occurs."

Auerbach said he doesn't know if legislation is the best way to solve the problem, but he added: "There's no question that this is something every institution needs to take seriously and address, as we have in Sturdy."

Dr. Daniel Corboy, with the Massachusetts College of Emergency Physicians, echoed Auerbach's concerns.

"We're not just crying wolf," he said. "It's not us just complaining about our work environment. It's really gotten intolerable and it's affecting patient safety." Corboy said part of the problem is there is no set definition of what constitutes overcrowding.

Currently, his organization says a patient waiting more than two hours to be treated constitutes overcrowding.

While that definition doesn't take into account the inflow/outflow differences Auerbach stresses, Corboy says it is a starting point.

"The legislation is meant to be very amorphous so a council will meet to set up parameters for what goals are reasonable for hospitals," he said.

"The bill is admittedly pretty tame," he said. "The idea is not to point fingers. It's to work together to solve the problem."

"It doesn't seem like things being done have helped," Corboy said. "It seems more like window dressing."