Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients
Open accessAbstract
Study objective We determine the effect of crowding on emergency department (ED) waiting room, treatment, and boarding times across multiple sites and acuity groups. Methods This was a retrospective cohort study that included ED visit and inpatient medicine occupancy data for a 1-year period at 4 EDs. We measured crowding at 30-minute intervals throughout each patient's ED stay. We estimated the effect of crowding on waiting room time, treatment time, and boarding time separately, using discrete-time survival analysis with time-dependent crowding measures (ie, number waiting, number being treated, number boarding, and inpatient medicine occupancy rate), controlling for patient demographic and clinical characteristics. Results Crowding substantially delayed patients' waiting room and boarding times but not treatment time. During the day shift, when the number boarding increased from the 50th to the 90th percentile, the adjusted median waiting room time (range 26 to 70 minutes) increased by 6% to 78% (range 33 to 82 minutes), and the adjusted median boarding time (range 250 to 626 minutes) increased by 15% to 47% (range 288 to 921 minutes), depending on the site. Crowding delayed the care of high-acuity level 2 patients at all sites. During crowded periods (ie, 90%), the adjusted median waiting room times of high-acuity level 2 patients were 3% to 35% higher than during normal periods, depending on the site and crowding measure. Conclusion Using discrete-time survival analysis, we were able to dynamically measure crowding throughout each patient's ED visit and demonstrate its deleterious effect on the timeliness of emergency care, even for high-acuity patients.
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A longer emergency department length of stay is associated with poor outcomes.
“A longer emergency department length of stay (EDLOS) is associated with poor outcomes.”
From Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study (2022) · cites this paper as [6]
The Introduction (page not available) calls ED length of stay an important measure of quality of care, and the Discussion reports that crowding lengthens ED stays and delays care. Neither passage establishes that a longer ED stay is associated with poor patient outcomes; the paper examines timeliness rather than that association. (LLM, conf=0.78)
Experimental — accuracy not yet measuredExtended lengths of stay lead to crowding in the ED, which is associated with worse outcomes, including death.
“Extended lengths of stay lead to crowding in the ED, which in turn is associated with worse outcomes, including death [6–8].”
From Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study (2022) · cites this paper as [6]
The Discussion says prolonged ED boarding impedes patient flow, supporting a link between extended stays and crowding. It also reports that crowding delays care, but the paper does not establish that crowding is associated with death; its principal finding is that crowding lengthens ED stays. Page numbers were not available in our copy. (LLM, conf=0.83)
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- Authors
- McCarthy, M. L., Zeger, S. L., Ding, R., Levin, S. R., Desmond, J. S., Lee, J., & Aronsky, D.
- Affiliations
- Johns Hopkins University (US)
- University of Michigan (US)
- George Washington University (US)
- Vanderbilt University Medical Center (US)
- Corresponding author
- McCarthy, Melissa L.
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 54
- Issue
- 4
- Pages
- 492-503.e4
- ISSN
- 0196-0644 (ISSN-L)
- OpenAlex
- W2150179549
- Cited by
- 367
- References
- 44
- Citations by year
- 2026: 16 · 2025: 12 · 2024: 20 · 2023: 18 · 2022: 18 · 2021: 26 · 2020: 26 · 2019: 24 · 2018: 22 · 2017: 27 · 2016: 20 · 2015: 31 · 2014: 26 · 2013: 27 · 2012: 19
- FWCI
- 18.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- emergency department overcrowding, emergency department length of stay, boarding time, treatment duration, high-acuity patients, discrete-time survival analysis
- MeSH terms
- Adolescent, Adult, Bed Occupancy, Emergency Service, Hospital, Female, Humans, Length of Stay, Male, Middle Aged, Patient Admission, Retrospective Studies, Time Factors, United States, Waiting Lists, Cohort Studies, Young Adult
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