Emergency department patients who stay more than 6 hours contribute to crowding.
BACKGROUND
Admitted and discharged patients with prolonged emergency department (ED) stays may contribute to crowding by utilizing beds and staff time that would otherwise be used for new patients.


OBJECTIVE
To describe patients who stay > 6 h in the ED and determine their association with measures of crowding.


METHODS
This was a retrospective, observational study carried out over 1 year at a single, urban, academic ED.


RESULTS
Of the 96,562 patients seen, 16,017 (17%) stayed > 6 h (51% admitted). When there was at least one patient staying > 6 h, 60% of the time there was at least one additional patient in the waiting room who could not be placed in an ED bed because none was open. The walk-out rate was 0.34 patients/hour when there were no patients staying in the ED > 6 h, vs. 0.77 patients/hour walking out when there were patients staying > 6 h in the ED (p < 0.001). When the ED contained more than 3 patients staying > 6 h, a trend was noted between increasing numbers of patients staying in the ED > 6 h and the percentage of time the ED was on ambulance diversion (p = 0.011).


CONCLUSIONS
In our ED, having both admitted and discharged patients staying > 6 h is associated with crowding.
Henneman
Philip L
PL
Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Nathanson
Brian H
BH
Li
Haiping
H
Smithline
Howard A
HA
Blank
Fidela S J
FS
Santoro
John P
JP
Maynard
Ann M
AM
Provost
Deborah A
DA
Henneman
Elizabeth A
EA
D000046:Academic Medical Centers / Q000458:organization & administration; D000552:Ambulances / Q000458:organization & administration; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008404:Massachusetts; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies