Annals of Emergency Medicine
Volume 54, Issue 4 , Pages 492-503.e4 , October 2009

Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients

  • Melissa L. McCarthy, ScD

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Corresponding Author InformationAddress for reprints: Melissa L. McCarthy, ScD, 5801 Smith Avenue, Davis Building Suite 3220, Department of Emergency Medicine, Baltimore, MD 21209; 410-735-6421, fax 410-735-6425
    • ,
  • Scott L. Zeger, PhD

      Affiliations

    • Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
    • ,
  • Ru Ding, MS

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Scott R. Levin, PhD

      Affiliations

    • Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Jeffrey S. Desmond, MD

      Affiliations

    • Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
    • ,
  • Jennifer Lee, MD

      Affiliations

    • Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC
    • ,
  • Dominik Aronsky, MD, PhD

      Affiliations

    • Department of Biomedical Informatics and the Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

Received 14 January 2009 ,Revised 25 February 2009 ,Accepted 3 March 2009.

  • Image Result

    The top half of the figure displays the values for 3 of the crowding measures at 30-minute intervals for a single, random day during the study period. This approach allowed us to capture any changes i

    The top half of the figure displays the values for 3 of the crowding measures at 30-minute intervals for a single, random day during the study period. This approach allowed us to capture any changes in these crowding factors every 30 minutes throughout the study period. The bottom half of the figure displays how we measured the completion of each phase of ED care for 6 randomly selected patients during the same day. Completion of waiting room time was measured every 15 minutes because it is typically short, whereas completion of treatment and boarding time was measured every 30 minutes.

  • Image Result
    The effect of different crowding factors averaged across the 4 sites on the adjusted waiting room time, treatment time, and boarding time for various levels of crowding. The time patients spend in the

    The effect of different crowding factors averaged across the 4 sites on the adjusted waiting room time, treatment time, and boarding time for various levels of crowding. The time patients spend in the waiting room or in the ED boarding increases sharply as the EDs become increasingly crowded.

  • Image Result
    Sample R code to predict median time to completion of ED care.

    Sample R code to predict median time to completion of ED care.

  • Image Result
    Sample R code to predict median time to completion of ED care.

    Sample R code to predict median time to completion of ED care.

  • Image Result
    Sample R code to predict median time to completion of ED care.

    Sample R code to predict median time to completion of ED care.

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 Supervising editor: Donald M. Yealy, MD

 Author contributions: All of the authors were involved in the study concept and design, drafting of the article, and critical revision of the article for important intellectual content. The objectives, data collection protocol, review of the analysis, and findings were discussed by teleconference calls with all of the investigators. MLM, JSD, JL, and DA were responsible for acquiring the data from their sites and obtaining institutional review board approval. RD performed the data analysis under the supervision of MLM and SLZ. However, all of the authors had input into the variables considered for the analysis and how it was conducted. MLM drafted the article, and all authors contributed substantially to its revision. MLM takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Publication date: Available online May 6, 2009.

PII: S0196-0644(09)00239-X

doi: 10.1016/j.annemergmed.2009.03.006

Annals of Emergency Medicine
Volume 54, Issue 4 , Pages 492-503.e4 , October 2009

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