Skip to main content
SpringerLink
Log in

The Consequences of Emergency Department Crowding and Delays for Patients

  • Chapter
  • First Online:
Patient Flow

Part of the book series: International Series in Operations Research & Management Science ((ISOR,volume 206))

Abstract

Emergency department crowding and the consequential delays in patient care have been long-standing problems, but as recently as 10 years ago, there was little evidence of their impact on patients. Since that time, there has been a substantial and convincing number of studies published indicating that crowding and delays compromise access to emergency care, quality of emergency care delivered, and patient outcomes, including survival. Further, there is evidence that these threats to patient well-being are more prevalent among vulnerable populations, specifically racial and ethnic minorities. This chapter presents results of recent studies that investigated the relationship between emergency department delays and crowding and patient outcomes. It concludes with a discussion about strategies to reduce crowding and delays.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ackroyd-Stolarz, S., Read Guernsey, J., Mackinnon, N. J., & Kovacs, G. (2011). The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: A retrospective cohort study. BMJ Quality and Safety, 20(7), 564–569.

    Article  Google Scholar 

  • American College of Emergency Physicians. (2008). Emergency department crowding: High-impact solutions. Dallas, TX: ACEP.

    Google Scholar 

  • Baker, D. W., Stevens, C. D., & Brook, R. H. (1991). Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. Journal of the American Medical Association, 266(8), 1085–1090.

    Article  Google Scholar 

  • Begley, C. E., Chang, Y., Wood, R. C., & Weltge, A. (2004). Emergency department diversion and trauma mortality: Evidence from Houston, Texas. The Journal of Trauma, 57(6), 1260–1265.

    Article  Google Scholar 

  • Boyle, A. B., Beniuk, K., Higginson, I., & Atkinson, P. (2012). Emergency department crowding: Time for interventions and policy evaluations. Emergency Medicine International, 2012, 838610.

    Article  Google Scholar 

  • Burt, C., McCaig, L., & Valverde, R. (2006). Analysis of ambulance transports and diversions among US emergency departments. Annals of Emergency Medicine, 47(4), 317–326.

    Article  Google Scholar 

  • Carter, A. W., Pilcher, D., Bailey, M., Cameron, P., Duke, G. J., & Cooper, J. (2010). Is ED length of stay before ICU admission related to patient mortality? Emergency Medicine Australasia, 22(2), 145–150.

    Article  Google Scholar 

  • Cha, W. C., Shin, S. D., Cho, J. S., Song, K. J., Singer, A. J., & Kwak, Y. H. (2011). The association between crowding and mortality in admitted pediatric patients from mixed adult-pediatric emergency departments in Korea. Pediatric Emergency Care, 27(12), 1136–1141.

    Article  Google Scholar 

  • Chalfin, D. B., Trzeciak, S., Likourezos, A., Baumann, B. M., & Dellinger, R. P. (2007). Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Critical Care Medicine, 35(6), 1477–1483. doi:10.1097/01.CCM.0000266585.74905.5A.

    Article  Google Scholar 

  • Clarey, A. J., & Cooke, M. W. (2011). Patients who leave emergency departments without being seen: Literature review and English data analysis. Emergency Medicine Journal. doi:10.1136/emermed-2011-200537.

    Google Scholar 

  • Clark, K., & Normile, L. B. (2007). Influence of time-to-interventions for emergency department critical care patients on hospital mortality. Journal of Emergency Nursing, 33(1), 6–13.

    Article  Google Scholar 

  • Cooney, D. R., Millin, M. G., Carter, A., Lawner, B. J., Nable, J. V., & Wallus, H. J. (2011). Ambulance diversion and emergency department offload delay: Resource document for the National Association of EMS Physicians position statement. Prehospital Emergency Care, 15(4), 555–561. doi:10.3109/10903127.2011.608871.

    Article  Google Scholar 

  • Di Bartolomeo, S., Valent, F., Rosolen, V., Sanson, G., Nardi, G., Cancellieri, F., & Barbone, F. (2007). Are pre-hospital time and emergency department disposition time useful process indicators for trauma care in Italy? Injury, 38(3), 305–311.

    Article  Google Scholar 

  • Diercks, D. B., Kirk, J. D., Lindsell, C. J., Pollack, C. V., Jr., Hoekstra, J. W., Gibler, W. B., & Hollander, J. E. (2006). Door-to-ECG time in patients with chest pain presenting to the ED. The American Journal of Emergency Medicine, 24(1), 1–7.

    Article  Google Scholar 

  • Diercks, D. B., Roe, M. T., Chen, A. Y., Peacock, W. F., Kirk, J. D., Pollack, C. V., Jr., et al. (2007). Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Annals of Emergency Medicine, 50(5), 489–496.

    Article  Google Scholar 

  • Eckstein, M., & Chan, L. S. (2004). The effect of emergency department crowding on paramedic ambulance availability. Annals of Emergency Medicine, 43(1), 100–105.

    Article  Google Scholar 

  • El-Mallakh, R. S., Whiteley, A., Wozniak, T., Ashby, M., Brown, S., Colbert-Trowel, D., et al. (2012). Waiting room crowding and agitation in a dedicated psychiatric emergency service. Annals of Clinical Psychiatry, 24(2), 140–142.

    Google Scholar 

  • Epstein, S. K., Huckins, D. S., Liu, S. W., Pallin, D. J., Sullivan, A. F., Lipton, R. I., & Camargo, C. A., Jr. (2012). Emergency department crowding and risk of preventable medical errors. Internal and Emergency Medicine, 7(2), 173–180.

    Article  Google Scholar 

  • Fee, C., Weber, E. J., Maak, C. A., & Bacchetti, P. (2007). Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia. Annals of Emergency Medicine, 50(5), 501–509, 509.e1.

    Article  Google Scholar 

  • Fernandes, C. M., Daya, M. R., Barry, S., & Palmer, N. (1994). Emergency department patients who leave without seeing a physician: The Toronto hospital experience. Annals of Emergency Medicine, 24(6), 1092–1096. doi: S0196064494002416 [pii].

    Article  Google Scholar 

  • Fernandes, C. M., Price, A., & Christenson, J. M. (1997). Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? The Journal of Emergency Medicine, 15(3), 397–399. doi: S0736467997000309 [pii].

    Article  Google Scholar 

  • Flabouris, A., Jeyadoss, J., Field, J., & Soulsby, T. (2013). Association between emergency department length of stay and outcome of patients admitted either to a ward, intensive care or high dependency unit. Emergency Medicine Australasia, 25(1), 46–54.

    Article  Google Scholar 

  • Forster, A. J., Stiell, G., Wells, A., Lee, C., & van Walraven, C. (2003). The effect of hospital occupancy on emergency department length of stay and patient disposition. Academic Emergency Medicine, 10(2), 127–133.

    Article  Google Scholar 

  • Gaieski, D. F., Mikkelsen, M. E., Band, R. A., Pines, J. M., Massone, R., Furia, F. F., et al. (2010). Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Critical Care Medicine, 38(4), 1045–1053.

    Article  Google Scholar 

  • General Accountability Office. (2009). Hospital emergency departments. Crowding continues to occur, and some patients wait longer than recommended time frames. Washington, DC: General Accountability Office.

    Google Scholar 

  • Herring, A., Wilper, A., Himmelstein, D. U., Woolhandler, S., Espinola, J. A., Brown, D. F., & Camargo, C. A., Jr. (2009). Increasing length of stay among adult visits to U.S. emergency departments, 2001–2005. Academic Emergency Medicine, 16(7), 609–616.

    Article  Google Scholar 

  • Hing, E., & Bhuiya, F. (2012). Wait time for treatment in hospital emergency departments: 2009. In NCH Statistics (Ed.), NCHS data brief. Atlanta: US Department of Health and Human Services.

    Google Scholar 

  • Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136.

    Article  Google Scholar 

  • Horwitz, L. I., & Bradley, E. H. (2009). Percentage of US emergency department patients seen within the recommended triage time: 1997 to 2006. Archives of Internal Medicine, 169(20), 1857–1865. doi:10.1001/archinternmed.2009.336.

    Article  Google Scholar 

  • Horwitz, L. I., Green, J., & Bradley, E. H. (2010). US emergency department performance on wait time and length of visit. Annals of Emergency Medicine, 55(2), 133–141.

    Article  Google Scholar 

  • Hsia, R. Y., Asch, S. M., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., et al. (2011a). Hospital determinants of emergency department left without being seen rates. Annals of Emergency Medicine, 58(1), 24.e3–32.e3. doi:10.1016/j.annemergmed.2011.01.009.

    Article  Google Scholar 

  • Hsia, R. Y., Kellermann, A. L., & Shen, Y. C. (2011b). Factors associated with closures of emergency departments in the United States. Journal of the American Medical Association, 305(19), 1978–1985. doi:10.1001/jama.2011.620.

    Google Scholar 

  • Hwang, U., Aufses, A. H., Jr., & Bickell, N. A. (2011a). Factors associated with delays to emergency care for bowel obstruction. The American Journal of Surgery, 202(1), 1–7.

    Article  Google Scholar 

  • Hwang, U., Richardson, L., Livote, E., Harris, B., Spencer, N., & Sean Morrison, R. (2008). Emergency department crowding and decreased quality of pain care. Academic Emergency Medicine, 15(12), 1248–1255.

    Article  Google Scholar 

  • Hwang, U., Richardson, L. D., Sonuyi, T. O., & Morrison, R. S. (2006). The effect of emergency department crowding on the management of pain in older adults with hip fracture. Journal of the American Geriatrics Society, 54(2), 270–275. doi:10.1111/j.1532-5415.2005.00587.x.

    Article  Google Scholar 

  • Hwang, U., Weber, E. J., Richardson, L. D., Sweet, V., Todd, K., Abraham, G., & Ankel, F. (2011b). A research agenda to assure equity during periods of emergency department crowding. Academic Emergency Medicine, 18(12), 1318–1323. doi:10.1111/j.1553-2712.2011.01233.x.

    Article  Google Scholar 

  • Intas, G., Stergiannis, P., Chalari, E., Tsoumakas, K., & Fildissis, G. (2012). The impact of ED boarding time, severity of illness, and discharge destination on outcomes of critically ill ED patients. Advanced Emergency Nursing Journal, 34(2), 164–169.

    Article  Google Scholar 

  • IOM. (2001). Crossing the quality chasm. Washington, DC: National Academy Press.

    Google Scholar 

  • IOM. (2006). Hospital-based emergency care: At the breaking point. Washington, DC: National Academy Press.

    Google Scholar 

  • James, C. A., Bourgeois, F. T., & Shannon, M. W. (2005). Association of race/ethnicity with emergency department wait times. Pediatrics, 115(3), e310–e315.

    Article  Google Scholar 

  • Jo, S., Kim, K., Lee, J. H., Rhee, J. E., Kim, Y. J., Suh, G. J., & Jin, Y. H. (2012). Emergency department crowding is associated with 28-day mortality in community-acquired pneumonia patients. The Journal of Infection, 64(3), 268–275.

    Article  Google Scholar 

  • Kennebeck, S. S., Timm, N. L., Kurowski, E. M., Byczkowski, T. L., & Reeves, S. D. (2011). The association of emergency department crowding and time to antibiotics in febrile neonates. Academic Emergency Medicine, 18(12), 1380–1385.

    Article  Google Scholar 

  • Kim, Y. J. (2011). The impact of time from ED arrival to surgery on mortality and hospital length of stay in patients with traumatic brain injury. Journal of Emergency Nursing, 37(4), 328–333.

    Article  Google Scholar 

  • Knox, D. K., & Holloman, G. H., Jr. (2012). Use and avoidance of seclusion and restraint: Consensus statement of the American association for emergency psychiatry project Beta seclusion and restraint workgroup. Western Journal of Emergency Medicine, 13(1), 35–40. doi:10.5811/westjem.2011.9.6867.

    Article  Google Scholar 

  • Kulstad, E. B., Sikka, R., Sweis, R. T., Kelley, K. M., & Rzechula, K. H. (2010). ED overcrowding is associated with an increased frequency of medication errors. The American Journal of Emergency Medicine, 28(3), 304–309.

    Article  Google Scholar 

  • Lee, C. C., Lee, N. Y., Chuang, M. C., Chen, P. L., Chang, C. M., & Ko, W. C. (2012). The impact of overcrowding on the bacterial contamination of blood cultures in the ED. The American Journal of Emergency Medicine, 30(6), 839–845.

    Article  Google Scholar 

  • Liu, S. W., Chang, Y., Weissman, J. S., Griffey, R. T., Thomas, J., Nergui, S., et al. (2011). An empirical assessment of boarding and quality of care: Delays in care among chest pain, pneumonia, and cellulitis patients. Academic Emergency Medicine, 18(12), 1339–1348.

    Article  Google Scholar 

  • Liu, S. W., Hamedani, A. G., Brown, D. F., Asplin, B., & Camargo, C. A., Jr. (2013). Established and novel initiatives to reduce crowding in emergency departments. Western Journal of Emergency Medicine, 14(2), 85–89. doi:10.5811/westjem.2012.11.12171.

    Google Scholar 

  • Liu, S. W., Thomas, S. H., Gordon, J. A., Hamedani, A. G., & Weissman, J. S. (2009). A pilot study examining undesirable events among emergency department-boarded patients awaiting inpatient beds. Annals of Emergency Medicine, 54(3), 381–385.

    Article  Google Scholar 

  • Magid, D. J., Asplin, B. R., & Wears, R. L. (2004). The quality gap: Searching for the consequences of emergency department crowding. Annals of Emergency Medicine, 44(6), 586–588.

    Article  Google Scholar 

  • McClelland, M. S., Jones, K., Siegel, B., & Pines, J. M. (2012). A field test of time-based emergency department quality measures. Annals of Emergency Medicine, 59(1), 1.e2–10.e2.

    Article  Google Scholar 

  • McNamara, R. L., Herrin, J., Wang, Y., Curtis, J. P., Bradley, E. H., Magid, D. J., et al. (2007). Impact of delay in door-to-needle time on mortality in patients with ST-segment elevation myocardial infarction. The American Journal of Cardiology, 100(8), 1227–1232.

    Article  Google Scholar 

  • Mills, A. M., Shofer, F. S., Chen, E. H., Hollander, J. E., & Pines, J. M. (2009). The association between emergency department crowding and analgesia administration in acute abdominal pain patients. Academic Emergency Medicine, 16(7), 603–608.

    Article  Google Scholar 

  • Mohsin, M., Forero, R., Ieraci, S., Bauman, A. E., Young, L., & Santiano, N. (2007). A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emergency Medicine Journal, 24(3), 175–179. doi: 24/3/175 [pii].

    Article  Google Scholar 

  • Monzon, J., Friedman, S. M., Clarke, C., & Arenovich, T. (2005). Patients who leave the emergency department without being seen by a physician: A control-matched study. Canadian Journal of Emergency Medical Care, 7(2), 107–113. doi: 5F7AC634DAFE4F7BBB08F817B0EA33B4 [pii].

    Google Scholar 

  • Moskop, J. C., Sklar, D. P., Geiderman, J. M., Schears, R. M., & Bookman, K. J. (2009). Emergency department crowding, part 1 – Concept, causes, and moral consequences. Annals of Emergency Medicine, 53(5), 605–611.

    Article  Google Scholar 

  • Mowery, N. T., Dougherty, S. D., Hildreth, A. N., Holmes, J. H., 4th, Chang, M. C., Martin, R. S., Hoth, J. J., Meredith, J. W., & Miller, P. R. (2011). Emergency department length of stay is an independent predictor of hospital mortality in trauma activation patients. The Journal of Trauma, 70(6), 1317–1325.

    Article  Google Scholar 

  • Niska, R. W., Bhuiya, F., & Xu, J. (2010). National hospital ambulatory medical care survey: 2007 emergency department summary. National health statistics reports, no. 7. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Nottidge, M. E., Ding, R., Zeger, S. L., Kelen, G. D., Steinwachs, D. M., & McCarthy, M. L. (2009). Racial and ethnic disparities in emergency department triage (Abstract). Academic Emergency Medicine, 16(4), S273.

    Google Scholar 

  • Office, G. A. (2003). Hospital emergency departments: Crowded conditions vary among hospitals and communities. Washington, DC: GAO.

    Google Scholar 

  • One-third of EDs may fail to meet 90-minute target for heart attack patients. (2007). ED Management, 19(1): 1–3.

    Google Scholar 

  • Park, C. Y., Lee, M. A., & Epstein, A. J. (2009). Variation in emergency department wait times for children by race/ethnicity and payment source. Health Services Research, 44(6), 2022–2039.

    Article  Google Scholar 

  • Pham, J. C., Ho, G. K., Hill, P. M., McCarthy, M. L., & Pronovost, P. J. (2009). National study of patient, visit, and hospital characteristics associated with leaving an emergency department without being seen: Predicting LWBS. Academic Emergency Medicine, 16(10), 949–955. doi:10.1111/j.1553-2712.2009.00515.x.

    Article  Google Scholar 

  • Pham, J. C., Patel, R., Millin, M. G., Kirsch, T. D., & Chanmugam, A. (2006). The effects of ambulance diversion: A comprehensive review. Academic Emergency Medicine, 13(11), 1220–1227.

    Article  Google Scholar 

  • Pines, J. M., Hilton, J. A., Weber, E. J., et al. (2011). International perspectives on emergency department crowding. Academic Emergency Medicine, 18(12), 1358–1370.

    Article  Google Scholar 

  • Pines, J., & Hollander, J. (2008). Emergency department crowding is associated with poor care for patients with severe pain. Annals of Emergency Medicine, 51, 1–5.

    Article  Google Scholar 

  • Pines, J. M., & McCarthy, M. L. (2011). Executive summary: Interventions to improve quality in the crowded emergency department. Academic Emergency Medicine, 18(12), 1229–1233. doi:10.1111/j.1553-2712.2011.01228.x.

    Article  Google Scholar 

  • Pines, J. M., Pollack, C. V., Jr., Diercks, D. B., Chang, A. M., Shofer, F. S., & Hollander, J. E. (2009a). The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Academic Emergency Medicine, 16(7), 617–625.

    Article  Google Scholar 

  • Pines, J. M., Russell Localio, A., & Hollander, J. E. (2009b). Racial disparities in emergency department length of stay for admitted patients in the United States. Academic Emergency Medicine, 16(5), 403–410.

    Article  Google Scholar 

  • Plunkett, P. K., Byrne, D. G., Breslin, T., Bennett, K., & Silke, B. (2011). Increasing wait times predict increasing mortality for emergency medical admissions. European Journal of Emergency Medicine, 18(4), 192–196.

    Article  Google Scholar 

  • Quattromani, E., Powell, E. S., Khare, R. K., Cheema, N., Sauser, K., Periyanayagam, U., Pirotte, M. J., Feinglass, J., & Courtney, M. D. (2011). Hospital-reported data on the pneumonia quality measure “Time to First Antibiotic Dose” are not associated with inpatient mortality: Results of a nationwide cross-sectional analysis. Academic Emergency Medicine, 18(5), 496–503.

    Article  Google Scholar 

  • Rathlev, N. K., Chessare, J., Olshaker, D., et al. (2007). Time series analysis of variables associated with daily mean emergency department length of stay. Annals of Emergency Medicine, 49(3), 265–271.

    Article  Google Scholar 

  • Richardson, D. B. (2006). Increase in patient mortality at 10 days associated with emergency department overcrowding. The Medical Journal of Australia, 184(5), 213–216.

    Google Scholar 

  • Rowe, B. H., Channan, P., Bullard, M., Blitz, S., Saunders, L. D., Rosychuk, R. J., Lari, H., Craig, W. R., & Holroyd, B. R. (2006). Characteristics of patients who leave emergency departments without being seen. Academic Emergency Medicine, 13(8), 848–852. doi:10.1197/j.aem.2006. 01.028.

    Article  Google Scholar 

  • Ryb, G. E., Cooper, C., & Waak, S. M. (2012). Delayed trauma team activation: Patient characteristics and outcomes. The Journal of Trauma and Acute Care Surgery, 73(3), 695–698.

    Article  Google Scholar 

  • Saukkonen, K. A., Varpula, M., Rasanen, P., Roine, R. P., Voipio-Pulkki, L. M., & Pettila, V. (2006). The effect of emergency department delay on outcome in critically ill medical patients: Evaluation using hospital mortality and quality of life at 6 months. Journal of Internal Medicine, 260(6), 586–591.

    Article  Google Scholar 

  • Schull, M. J., Kiss, A., & Szalai, J. P. (2007). The effect of low-complexity patients on emergency department waiting times. Annals of Emergency Medicine, 49(3), 257–264.

    Article  Google Scholar 

  • Schull, M. J., Vermeulen, M., Slaughter, G., Morrison, L., & Daly, P. (2004). Emergency department crowding and thrombolysis delays in acute myocardial infarction. Annals of Emergency Medicine, 44(6), 577–585.

    Article  Google Scholar 

  • Servia, L., Badia, M., Baeza, I., Montserrat, N., Justes, M., Cabre, X., Valdres, P., & Trujillano, J. (2012). Time spent in the emergency department and mortality rates in severely injured patients admitted to the intensive care unit: An observational study. Journal of Critical Care, 27(1), 58–65.

    Article  Google Scholar 

  • Shaikh, S. B., Jerrard, D. A., Witting, M. D., Winters, M. E., & Brodeur, M. N. (2012). How long are patients willing to wait in the emergency department before leaving without being seen? Western Journal of Emergency Medicine, 13(6), 463–467. doi: 10.5811/westjem.2012.3.6895, wjem-13-463 [pii].

    Article  Google Scholar 

  • Shen, Y. C., & Hsia, R. Y. (2011). Association between ambulance diversion and survival among patients with acute myocardial infarction. Journal of the American Medical Association, 305(23), 2440–2447.

    Article  Google Scholar 

  • Shen, Y. C., Hsia, R. Y., & Kuzma, K. (2009). Understanding the risk factors of trauma center closures: Do financial pressure and community characteristics matter? Medical Care, 47(9), 968–978. doi: 10.1097/MLR.0b013e31819c941500005650-200909000-00006 [pii].

    Article  Google Scholar 

  • Shenoi, R., Ma, L., Syblik, D., & Yusuf, S. (2011). Emergency department crowding and analgesic delay in pediatric sickle cell pain crises. Pediatric Emergency Care, 27(10), 911–917.

    Article  Google Scholar 

  • Sills, M. R., Fairclough, D., Ranade, D., & Kahn, M. G. (2011a). Emergency department crowding is associated with decreased quality of care for children with acute asthma. Annals of Emergency Medicine, 57(3), 191–200.

    Article  Google Scholar 

  • Sills, M. R., Fairclough, D. L., Ranade, D., Mitchell, M. S., & Kahn, M. G. (2011b). Emergency department crowding is associated with decreased quality of analgesia delivery for children with pain related to acute, isolated, long-bone fractures. Academic Emergency Medicine, 18(12), 1330–1338.

    Article  Google Scholar 

  • Singer, A. J., Thode, H. C., Jr., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324–1329.

    Article  Google Scholar 

  • Sklar, D. P., Crandall, C. S., Zola, T., & Cunningham, R. (2010). Emergency physician perceptions of patient safety risks. Annals of Emergency Medicine, 55(4), 336–340.

    Article  Google Scholar 

  • Soremekun, O. A., Terwiesch, C., & Pines, J. M. (2011). Emergency medicine: An operations management view. Academic Emergency Medicine, 18(12), 1262–1268. doi:10.1111/j.1553-2712.2011.01226.x.

    Article  Google Scholar 

  • Sprivulis, P. C., Da Silva, J. A., Jacobs, I. G., Frazer, A. R., & Jelinek, G. A. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. The Medical Journal of Australia, 184(5), 208–212.

    Google Scholar 

  • Weiss, S. J., Ernst, A. A., Derlet, R., King, R., Bair, A., & Nick, T. G. (2005). Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. The American Journal of Emergency Medicine, 23(3), 288–294.

    Article  Google Scholar 

  • Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Cutrona, S. L., Bor, D. H., & Himmelstein, D. U. (2008). Waits to see an emergency department physician: U.S. trends and predictors, 1997–2004. Health Affairs, 27(2), w84–w95. doi:10.1377/hlthaff.27.2.w84.

    Article  Google Scholar 

  • Wilson, B. J., Zimmerman, D., Applebaum, K. G., Kovalski, N., & Stein, C. (2012). Patients who leave before being seen in an urgent care setting. European Journal of Emergency Medicine, 11, 11.

    Google Scholar 

  • Wu, B. U., Banks, P. A., & Conwell, D. L. (2009). Disparities in emergency department wait times for acute gastrointestinal illnesses: Results from the National Hospital Ambulatory Medical Care Survey, 1997–2006. The American Journal of Gastroenterology, 104(7), 1668–1673.

    Article  Google Scholar 

  • Yankovic, N., Glied, S., Green, L. V., & Grams, M. (2010). The impact of ambulance diversion on heart attack deaths. Inquiry, 47(1), 81–91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northwestern University, Chicago, IL, USA

    Megan McHugh

Authors
  1. Megan McHugh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Megan McHugh .

Editor information

Editors and Affiliations

  1. Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA

    Randolph Hall

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

McHugh, M. (2013). The Consequences of Emergency Department Crowding and Delays for Patients. In: Hall, R. (eds) Patient Flow. International Series in Operations Research & Management Science, vol 206. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-9512-3_5

Download citation

Publish with us

Policies and ethics

Search

Navigation