Crowded emergency departments linked to more deaths, costs

High emergency department crowding is associated with increased inpatient mortality, as well as moderate rises in length of stay and costs, concludes a new study in the Annals of Emergency Medicine.

Patients admitted to the hospital during high ED crowding times had 5 percent greater risk of inpatient death than similar patients admitted to the same hospital when the ED was less crowded. 

The researchers looked at almost 1 million ED visits resulting in admission to 187 hospitals and used daily ambulance diversion to measure ED crowding, according to a research announcement today.

They found that on days with a median of seven ambulance diversion hours, admitted patients had a 0.8 percent longer hospital length of stay and 1 percent higher costs.

Moreover, high ED crowding was associated with 300 excess inpatient deaths, 6,200 hospital days and $17 million in costs, the study noted.

Such findings are even more worrisome, given that half of health leaders say their ERs are overcrowded as is. Overcrowding is growing twice as fast as ER visits.

Hospitals looking to make their EDs less crowded should target Medicare patients, as almost 60 percent of their ER visits were "potentially preventable."  

However, contrary to popular belief, nonurgent, Medicaid patients aren't clogging up the ED. Most Medicaid ED patients go because they have to, seeking emergent care for serious medical problems. Instead, most crowding stems from ED boarding, in which emergency patients admitted to the hospital are waiting for an inpatient bed, FierceHealthcare previously reported.

Researchers say the new study reinforces calls to end ED boarding. "Prolonged boarding times may delay definitive testing and increase short-term mortality, length of stay, and associated costs," the study states.

For more:
- read the study (.pdf)
- here's the ACEP announcement