The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.
The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review
Open accessAbstract
Purpose: Emergency department (ED) crowding is a significant patient safety concern associated with poor quality of care. The purpose of this systematic review is to assess the relationship between ED crowding and patient outcomes. Design: We searched the Medline search engine and relevant emergency medicine and nursing journals for studies published in the past decade that pertained to ED crowding and the following patient outcome measures: mortality, morbidity, patient satisfaction, and leaving the ED without being seen. All articles were appraised for study quality. Findings: A total of 196 abstracts were screened and 11 articles met inclusion criteria. Three of the eleven studies reported a significant positive relationship between ED crowding and mortality either among patients admitted to the hospital or discharged home. Five studies reported that ED crowding is associated with higher rates of patients leaving the ED without being seen. Measures of ED crowding varied across studies. Conclusions: ED crowding is a major patient safety concern associated with poor patient outcomes. Interventions and policies are needed to address this significant problem. Clinical Relevance: This review details the negative patient outcomes associated with ED crowding. Study results are relevant to medical professionals and those that seek care in the ED.
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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 [8]
The Results section (page unavailable) reports higher 7-day mortality among patients discharged during shifts with a mean ED length of stay of at least 6 hours than during shifts with a mean below 1 hour. This supports an association between longer shift-level ED stays and a poor outcome, but does not establish that a longer individual patient's ED stay is associated with poor outcomes. (LLM, conf=0.86)
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 [8]
The Clinical Relevance section links extended ED boarding and crowding to insufficient inpatient capacity, but does not establish that extended lengths of stay themselves cause crowding. The Conclusions report that ED crowding is associated with higher mortality, supporting the second part of the claim. Page numbers are unavailable in our copy. (LLM, conf=0.82)
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Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010) · International Journal of Surgery · doi:10.1016/j.ijsu.2010.02.007 · Cited by 12,156
Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions
Hoot, N. R., & Aronsky, D. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2008.03.014 · Cited by 1,689
The Effect of Emergency Department Crowding on Clinically Oriented Outcomes
Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., McCarthy, M., John McConnell, K., Pines, J. M., Rathlev, N., et al. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00295.x · Cited by 1,147
Systems to rate the strength of scientific evidence.
West, S. L., King, V., Carey, T. S., Lohr, K. N., Mckoy, N. A., Sutton, S. F., & Lux, L. J. (2002) · PubMed Central · Cited by 873
Increase in patient mortality at 10 days associated with emergency department overcrowding
Richardson, D. B. (2006) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2006.tb00204.x · Cited by 829
Guttmann, A., Schull, M. J., Vermeulen, M. J., & Stukel, T. A. (2011) · BMJ · doi:10.1136/bmj.d2983 · Cited by 726
International Perspectives on Emergency Department Crowding
Pines, J. M., Hilton, J. A., Weber, E. J., Alkemade, A., Shabanah, H. A., Anderson, P. D., Bernhard, M., BERTINI, A., Gries, A., Ferrandiz, S., et al. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2011.01235.x · Cited by 644
National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary.
McCaig, L. F., & Burt, C. W. (2003) · PubMed · Cited by 582
Emergency Department Crowding, Part 1—Concept, Causes, and Moral Consequences
Moskop, J. C., Sklar, D. P., Geiderman, J. M., et al. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2008.09.019 · Cited by 512
Hospital-based emergency care: at the breaking point
(2008) · Choice Reviews Online · doi:10.5860/choice.45-2635 · Cited by 496
The Growing Role of Emergency Departments in Hospital Admissions
Schuur, J. D., & Venkatesh, A. K. (2012) · New England Journal of Medicine · doi:10.1056/nejmp1204431 · Cited by 357
The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients
Pines, J. M., Iyer, S., Disbot, M., Hollander, J. E., Shofer, F. S., & Datner, E. M. (2008) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00200.x · Cited by 349
How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts
James, B. C., & Savitz, L. A. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0358 · Cited by 308
Pines, J. M., Pollack, C. V., Diercks, D. B., Chang, A. M., Shofer, F. S., & Hollander, J. E. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2009.00456.x · Cited by 289
Pines, J. M., Localio, A. R., Hollander, J. E., Baxt, W. G., Lee, H., Phillips, C., & Metlay, J. P. (2007) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.07.021 · Cited by 287
Measures of Crowding in the Emergency Department: A Systematic Review
Hwang, U., McCarthy, M. L., Aronsky, D., Asplin, B. R., Crane, P. W., Craven, C. K., Epstein, S. K., Fee, C. R., Handel, D. A., Pines, J. M., et al. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2011.01054.x · Cited by 242
Pitts, S. R., Pines, J. M., Handrigan, M. T., & Kellermann, A. L. (2012) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2012.05.014 · Cited by 229
National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary.
McCaig, L. F., & Burt, C. W. (2001) · PubMed · Cited by 206
Weiss, S. J., Ernst, A. A., Derlet, R. W., et al. (2005) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2005.02.034 · Cited by 196
The Effect of Emergency Department Crowding on Patient Outcomes
Johnson, K. D., & Winkelman, C. (2011) · Advanced Emergency Nursing Journal · doi:10.1097/tme.0b013e318207e86a · Cited by 155
Zibulewsky, J. (2001) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2001.11927785 · Cited by 130
Factors Associated with Patients Who Leave without Being Seen
Polevoi, S. K., Quinn, J., & Kramer, N. R. (2005) · Academic Emergency Medicine · doi:10.1197/j.aem.2004.10.029 · Cited by 128
The effect of crowding on access and quality in an academic ED
Vieth, T. L., & Rhodes, K. V. (2006) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2006.03.026 · Cited by 128
Emergency Department Utilization After the Implementation of Massachusetts Health Reform
Smulowitz, P. B., Lipton, R. I., Wharam, J. F., Adelman, L. C., Weiner, S. G., Burke, L. G., Baugh, C. W., Schuur, J. D., Liu, S. W., McGrath, M. E., et al. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2011.02.020 · Cited by 87
Emergency Department Overcrowding: Analysis of the Factors of Renege Rate
Asaro, P. V., Lewis, L. M., & Boxerman, S. B. (2006) · Academic Emergency Medicine · doi:10.1197/j.aem.2006.08.011 · Cited by 83
ED Crowding Is Associated with Variable Perceptions of Care Compromise
Pines, J. M., Garson, C., Baxt, W. G., et al. (2007) · Academic Emergency Medicine · doi:10.1197/j.aem.2007.06.043 · Cited by 81
The Association of Emergency Department Crowding and Time to Antibiotics in Febrile Neonates
Kennebeck, S., Timm, N. L., Kurowski, E. M., et al. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2011.01221.x · Cited by 79
The Boarders in the Emergency Department (BED) study
Gilligan, P., Winder, S., Singh, I., et al. (2008) · Emergency Medicine Journal · doi:10.1136/emj.2007.048173 · Cited by 49
Cha, W. C., Shin, S. D., Cho, J. S., et al. (2011) · Pediatric Emergency Care · doi:10.1097/pec.0b013e31823ab90b · Cited by 48
McClelland, M. S., Lazar, D., Sears, V., Wilson, M. J., Siegel, B., & Pines, J. M. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2011.01229.x · Cited by 35
Kulstad, E. B., Hart, K. M., & WAGHCHOURE, S. S. (2010) · PubMed · Cited by 35
Infection Prevention in Long‐Term Care: A Systematic Review of Randomized and Nonrandomized Trials
Uchida, M., Pogorzelska‐Maziarz, M., Smith, P. W., et al. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12175 · Cited by 31
Emergency Nurses Association Position Statement: Crowding in the Emergency Department
(2006) · Journal of Emergency Nursing · doi:10.1016/j.jen.2005.09.023 · Cited by 24
Handel, D. A., Ginde, A. A., Raja, A. S., Rogers, J., Sullivan, A. F., Espinola, J. A., & Camargo, C. A. (2010) · International Journal of Emergency Medicine · doi:10.1007/s12245-010-0216-6 · Cited by 20
Flagged first, then by citations
Research works printed but not linked: 2
- Centers for Disease Control and Prevention, 2009, FastStats. Hospital utilization
- Emergency Medicine Network, 2014, 2011 National ED statistics
Cited by
Sorted by citations
Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland
Paulin, J., Kurola, J., Salanterä, S., Moen, H., Guragain, N., Koivisto, M., Käyhkö, N., Aaltonen, V., & Iirola, T. (2020) · Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · doi:10.1186/s13049-020-00741-w · Cited by 78
Vrijsen, B. E. L., Haitjema, S., Westerink, J., Hulsbergen-Veelken, C. A. R., van Solinge, W. W., & ten Berg, M. J. (2022) · BMC Emergency Medicine · doi:10.1186/s12873-022-00763-w · Cited by 20
Impact of Laboratory Turnaround Time on Clinical Decision-Making and Patient Outcomes
Alanazi, A. G. J., Hanbouli, T. M. H. A., Albarqi, A. S. M., Aldoghmani Turki Kateb, D., Rowili, N. H. O. A., Jhory, K. E. A., Bokhari, A. M. K., Alanazi, A. A., Alenezi, T. M. R., Alawidia Ahmad Issa, A., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4675 · Cited by 1
“…internal quality improvement, laboratories often break this down into distinct, measurable intervals: the pre-analytical phase (order to specimen receipt), the analytical phase (specimen processing to result generation), and the post-analytical phase (result verification to report delivery) [7-9].”
Metadata
- Authors
- Carter, E. J., Pouch, S. M., & Larson, E. L.
- Affiliations
- Columbia University (US)
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Carter, Eileen J.
- Venue
- Journal of Nursing Scholarship
- Publisher
- Wiley
- Published
- 2013-12-19
- Volume
- 46
- Issue
- 2
- Pages
- 106-115
- ISSN
- 0363-2792 (ISSN-L)
- 1527-6546
- 1547-5069
- PMC
- PMC4033834
- OpenAlex
- W2154723371
- Cited by
- 410
- References
- 35
- Citations by year
- 2026: 25 · 2025: 38 · 2024: 28 · 2023: 41 · 2022: 41 · 2021: 31 · 2020: 46 · 2019: 43 · 2018: 43 · 2017: 24 · 2016: 23 · 2015: 21 · 2014: 6
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Nursing Scholarship (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention
- National Institute of Nursing Research (F31NR014599, T32NR013454)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
- Keywords
- emergency department overcrowding, patient outcomes, patient safety, mortality, morbidity, patient satisfaction, left without being seen
- MeSH terms
- Crowding, Emergency Service, Hospital, Humans, Quality of Health Care, Patient Safety, Patient Outcome Assessment
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