title: Pediatric emergency department overcrowding and impact on patient flow outcomes.
abstract: BACKGROUND
  Understanding the impact of overcrowding in pediatric emergency departments (PEDs) on quality of care is a growing concern. Boarding admitted patients in the PED and increasing emergency department (ED) visits are two potentially significant factors affecting quality of care.
  
  
  OBJECTIVE
  The objective was to describe the impact ED boarding time and daily census have on the timeliness of care in a PED.
  
  
  METHODS
  Pediatric ED boarding time and daily census were determined each day from July 2003 to July 2007. Outcome measures included mean length of stay (LOS), time to triage, time to physician, and patient elopement during a 24-hour period.
  
  
  RESULTS
  For every 50 patients seen above the average daily volume of 250, LOS increased 14.8 minutes, time to triage increased 6.6 minutes, time to physician increased 18.2 minutes, and number of patient elopements increased by three. For each increment of 24 hours to total ED boarding time, LOS increased 7.6 minutes, time to triage increased 0.6 minutes, time to physician increased 3 minutes, and number of patient elopements increased by 0.6 patients.
  
  
  CONCLUSIONS
  ED boarding time and ED daily census show independent associations with increasing overall LOS, time to triage, time to physician, and number of patient elopements in a PED.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Nathan.timm@cchmc.org
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Timm
authors.forename: Mona L
authors.initials: ML
authors.lastname: Ho
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Luria
mesh_terms: D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016012:Poisson Distribution; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D017748:Time Management / Q000379:methods; D013996:Time and Motion Studies