Emergency Department and Hospital Crowding: Causes, Consequences, and Cures

Overview

Journal Clin Exp Emerg Med

Specialty Emergency Medicine

Date 2019 Jul 13

PMID 31295991

Citations 71

Authors

Peter McKenna

Samita M Heslin

Peter Viccellio

William K Mallon

Cristina Hernandez

Eric J Morley

Affiliations

Soon will be listed here.

Abstract

Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughput due to staffing, ancillary service performance, and flow processes. As such, the problem may be addressed by process improvements within the ED. A broad body of literature demonstrates that ED overcrowding can be a function of hospital capacity rather than an ED specific issue. Lack of institutional capacity leads to boarding in the ED with resultant ED crowding. This is a problem not solvable by the ED and must be addressed as an institution-wide problem. This paper discusses the causes of ED overcrowding, provides a brief overview of the drastic consequences, and discusses possible cures that have been successfully implemented.

Citing Articles

Correlation Between Emergency Department Crowding and Adverse Occurrences in an Academic Hospital: A Retrospective Cohort Study.

Alassaf W, Albrahim R, Abukhaled J, Aldhaif M, Mohammed M, Al Baiz A Risk Manag Healthc Policy. 2025; 18:561-568.

PMID: 39990614 PMC: 11847434. DOI: 10.2147/RMHP.S504578.

A descriptive report on the impact of pharmacy workflows in the operational success of hospital at home implementation at a county academic hospital system.

Levy J, Wollen J, Nguyen P, Brimmer C, Dwivedi R, Tolleson S Explor Res Clin Soc Pharm. 2025; 17:100560.

PMID: 39871917 PMC: 11770489. DOI: 10.1016/j.rcsop.2025.100560.

Emergency department trends for inguinal hernia and gallbladder disease before and after COVID-19 scheduled surgery interruptions: lessons for hospital capacity management.

Lategan C, Wang X, Chisholm C, Hsu Z, Lang E CJEM. 2025; 27(2):134-143.

PMID: 39752086 DOI: 10.1007/s43678-024-00832-y.

Emergency department crowding: a national data report.

Chang H, Ko E, Lee J, Kim M, Kim T, Shin T Clin Exp Emerg Med. 2025; 11(4):331-334.

PMID: 39743308 PMC: 11700691. DOI: 10.15441/ceem.24.337.

Modulating throughput: practical emergency department (ED) flow models from a rural Canadian ED to directly increase patient throughput.

Liu K, Young C, Norman P, Yaremko H, Moellekaer A, Lim R Intern Emerg Med. 2024; .

PMID: 39633133 DOI: 10.1007/s11739-024-03834-x.

References

Litvak E, Fineberg H . Smoothing the way to high quality, safety, and economy. N Engl J Med. 2013; 369(17):1581-3. DOI: 10.1056/NEJMp1307699. View

Bekmezian A, Chung P . Boarding admitted children in the emergency department impacts inpatient outcomes. Pediatr Emerg Care. 2012; 28(3):236-42. DOI: 10.1097/PEC.0b013e3182494b94. View

Liu S, Thomas S, Gordon J, Hamedani A, Weissman J . A pilot study examining undesirable events among emergency department-boarded patients awaiting inpatient beds. Ann Emerg Med. 2009; 54(3):381-5. DOI: 10.1016/j.annemergmed.2009.02.001. View

Greene J . Emergency department flow and the boarded patient: how to get admitted patients upstairs. Ann Emerg Med. 2007; 49(1):68-70. DOI: 10.1016/j.annemergmed.2006.11.020. View

Ragavan M, Blinman T, Fieldston E . Scheduled surgery admissions and occupancy at a children's hospital: variation we can control to improve efficiency and value in health care delivery. Ann Surg. 2012; 257(3):564-70. DOI: 10.1097/SLA.0b013e3182683178. View

White B, Biddinger P, Chang Y, Grabowski B, Carignan S, Brown D . Boarding inpatients in the emergency department increases discharged patient length of stay. J Emerg Med. 2012; 44(1):230-5. DOI: 10.1016/j.jemermed.2012.05.007. View

Willard E, Carlton E, Moffat L, Barth B . A Full-Capacity Protocol Allows for Increased Emergency Patient Volume and Hospital Admissions. J Emerg Nurs. 2017; 43(5):413-418. DOI: 10.1016/j.jen.2017.01.007. View

Powell E, Khare R, Venkatesh A, Van Roo B, Adams J, Reinhardt G . The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2010; 42(2):186-96. DOI: 10.1016/j.jemermed.2010.06.028. View

Richardson D, Mountain D . Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust. 2009; 190(7):369-74. DOI: 10.5694/j.1326-5377.2009.tb02451.x. View

10.

Pines J, Russell Localio A, Hollander J, Baxt W, Lee H, Phillips C . The impact of emergency department crowding measures on time to antibiotics for patients with community-acquired pneumonia. Ann Emerg Med. 2007; 50(5):510-6. DOI: 10.1016/j.annemergmed.2007.07.021. View

11.

Viccellio P . Emergency department overcrowding: an action plan. Acad Emerg Med. 2001; 8(2):185-7. DOI: 10.1111/j.1553-2712.2001.tb01286.x. View

12.

Jo S, Kim K, Lee J, Rhee J, Kim Y, Suh G . Emergency department crowding is associated with 28-day mortality in community-acquired pneumonia patients. J Infect. 2012; 64(3):268-75. DOI: 10.1016/j.jinf.2011.12.007. View

13.

Hwang U, Richardson L, Livote E, Harris B, Spencer N, Morrison R . Emergency department crowding and decreased quality of pain care. Acad Emerg Med. 2008; 15(12):1248-55. PMC: 2729811. DOI: 10.1111/j.1553-2712.2008.00267.x. View

14.

Ye L, Zhou G, He X, Shen W, Gan J, Zhang M . Prolonged length of stay in the emergency department in high-acuity patients at a Chinese tertiary hospital. Emerg Med Australas. 2012; 24(6):634-40. DOI: 10.1111/j.1742-6723.2012.01588.x. View

15.

Sprivulis P, Da Silva J, Jacobs I, Frazer A, Jelinek G . The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006; 184(5):208-12. DOI: 10.5694/j.1326-5377.2006.tb00416.x. View

16.

Fieldston E, Ragavan M, Jayaraman B, Allebach K, Pati S, Metlay J . Scheduled admissions and high occupancy at a children's hospital. J Hosp Med. 2011; 6(2):81-7. DOI: 10.1002/jhm.819. View

17.

Krochmal P, Riley T . Increased health care costs associated with ED overcrowding. Am J Emerg Med. 1994; 12(3):265-6. DOI: 10.1016/0735-6757(94)90135-x. View

18.

Pines J, Heckman J . Emergency department boarding and profit maximization for high-capacity hospitals: challenging conventional wisdom. Ann Emerg Med. 2008; 53(2):256-8. DOI: 10.1016/j.annemergmed.2008.08.012. View

19.

Geelhoed G, de Klerk N . Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust. 2012; 196:122-6. DOI: 10.5694/mja11.11159. View

20.

Richardson D . The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust. 2002; 177(9):492-5. DOI: 10.5694/j.1326-5377.2002.tb04917.x. View