The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review

Authors

  • Eileen J. Carter RN, BSN,

    Corresponding author
    1. Doctoral Student, Columbia University School of Nursing, New York, NY, USA
    • Correspondence Eileen J. Carter, Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032. E-mail: em2473@columbia.edu

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  • Stephanie M. Pouch MD,

    1. Infectious Diseases Fellow, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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  • Elaine L. Larson PhD, RN, FAAN, CIC

    1. Associate Dean for Research, Columbia University Mailman School of Public Health, Columbia University School of Nursing, New York, NY, USA
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Abstract

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.

Ancillary