Presented at the Society for Academic Emergency Medicine (SAEM) Annual Meeting, Washington, DC, May 30, 2008.
The Effect of Emergency Department Crowding on Clinically Oriented Outcomes
Article first published online: 10 NOV 2008
© 2008 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 16, Issue 1, pages 1–10, January 2009
How to Cite
Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., McCarthy, M., John McConnell, K., Pines, J. M., Rathlev, N., Schafermeyer, R., Zwemer, F., Schull, M., Asplin, B. R. and Society for Academic Emergency Medicine, Emergency Department Crowding Task Force (2009), The Effect of Emergency Department Crowding on Clinically Oriented Outcomes. Academic Emergency Medicine, 16: 1–10. doi: 10.1111/j.1553-2712.2008.00295.x
Approved by the SAEM Board of Directors, July 9, 2008.
- Issue published online: 29 DEC 2008
- Article first published online: 10 NOV 2008
- Received July 16, 2008; revision received September 20, 2008; accepted September 22, 2008.
- emergency department crowding;
- quality of care;
- patient safety
Background: An Institute of Medicine (IOM) report defines six domains of quality of care: safety, patient-centeredness, timeliness, efficiency, effectiveness, and equity. The effect of emergency department (ED) crowding on these domains of quality has not been comprehensively evaluated.
Objectives: The objective was to review the medical literature addressing the effects of ED crowding on clinically oriented outcomes (COOs).
Methods: We reviewed the English-language literature for the years 1989–2007 for case series, cohort studies, and clinical trials addressing crowding’s effects on COOs. Keywords searched included “ED crowding,”“ED overcrowding,”“mortality,”“time to treatment,”“patient satisfaction,”“quality of care,” and others.
Results: A total of 369 articles were identified, of which 41 were kept for inclusion. Study quality was modest; most articles reflected observational work performed at a single institution. There were no randomized controlled trials. ED crowding is associated with an increased risk of in-hospital mortality, longer times to treatment for patients with pneumonia or acute pain, and a higher probability of leaving the ED against medical advice or without being seen. Crowding is not associated with delays in reperfusion for patients with ST-elevation myocardial infarction. Insufficient data were available to draw conclusions on crowding’s effects on patient satisfaction and other quality endpoints.
Conclusions: A growing body of data suggests that ED crowding is associated both with objective clinical endpoints, such as mortality, as well as clinically important processes of care, such as time to treatment for patients with time-sensitive conditions such as pneumonia. At least two domains of quality of care, safety and timeliness, are compromised by ED crowding.