The relationship between emergency department crowding and patient outcomes: a systematic review.

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.

[1]  A. Chang,et al.  The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[2]  Karin V Rhodes,et al.  The effect of crowding on access and quality in an academic ED. , 2006, The American journal of emergency medicine.

[3]  Arthur L Kellermann,et al.  National trends in emergency department occupancy, 2001 to 2008: effect of inpatient admissions versus emergency department practice intensity. , 2012, Annals of emergency medicine.

[4]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[5]  M. Mccarthy,et al.  Measures of crowding in the emergency department: a systematic review. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[6]  Astrid Guttmann,et al.  Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada , 2011, BMJ : British Medical Journal.

[7]  Karin V Rhodes,et al.  ED crowding is associated with variable perceptions of care compromise. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[8]  C. Winkelman,et al.  The Effect of Emergency Department Crowding on Patient Outcomes: A Literature Review , 2011, Advanced emergency nursing journal.

[9]  L. McCaig,et al.  National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. , 2001, Advance data.

[10]  D. Aronsky,et al.  Systematic review of emergency department crowding: causes, effects, and solutions. , 2008, Annals of emergency medicine.

[11]  J. Zibulewsky.  The Emergency Medical Treatment and Active Labor Act (Emtala): What It Is and What It Means for Physicians , 2001, Proceedings.

[12]  Lucy A Savitz,et al.  How Intermountain trimmed health care costs through robust quality improvement efforts. , 2011, Health affairs.

[13]  Jesse M Pines,et al.  International perspectives on emergency department crowding. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[14]  I. Singh,et al.  The Boarders in the Emergency Department (BED) study , 2008, Emergency Medicine Journal.

[15]  Jesse M Pines,et al.  The effect of emergency department crowding on patient satisfaction for admitted patients. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[16]  Arjun K Venkatesh,et al.  The growing role of emergency departments in hospital admissions. , 2012, The New England journal of medicine.

[17]  S. Kennebeck,et al.  The association of emergency department crowding and time to antibiotics in febrile neonates. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[18]  E. Kulstad,et al.  Occupancy Rates and Emergency Department Work Index Scores Correlate with Leaving Without Being Seen , 2010, The western journal of emergency medicine.

[19]  Jeremiah D. Schuur,et al.  Emergency department utilization after the implementation of Massachusetts health reform. , 2011, Annals of emergency medicine.

[20]  Todd G Nick,et al.  Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. , 2005, The American journal of emergency medicine.

[21]  Jesse M Pines,et al.  The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[22]  David P Sklar,et al.  Emergency department crowding, part 1--concept, causes, and moral consequences. , 2009, Annals of emergency medicine.

[23]  N McKoy,et al.  Systems to rate the strength of scientific evidence. , 2002, Evidence report/technology assessment.

[24]  A Russell Localio,et al.  The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. , 2007, Annals of emergency medicine.

[25]  C. Camargo,et al.  Implementation of crowding solutions from the American College of Emergency Physicians Task Force Report on Boarding , 2010, International journal of emergency medicine.

[26]  Lawrence M Lewis,et al.  Emergency department overcrowding: analysis of the factors of renege rate. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[27]  Emergency Nurses Association position statement: crowding in the emergency department. , 2006, Journal of Emergency Nursing.

[28]  Steven L Bernstein,et al.  The effect of emergency department crowding on clinically oriented outcomes. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  Philip Smith,et al.  Infection Prevention in Long‐Term Care: A Systematic Review of Randomized and Nonrandomized Trials , 2013, Journal of the American Geriatrics Society.

[30]  S. Polevoi,et al.  Factors associated with patients who leave without being seen. , 2005, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[31]  D. Richardson,et al.  Increase in patient mortality at 10 days associated with emergency department overcrowding , 2006, The Medical journal of Australia.

[32]  A. Singer,et al.  The Association Between Crowding and Mortality in Admitted Pediatric Patients From Mixed Adult-Pediatric Emergency Departments in Korea , 2011, Pediatric emergency care.