title: Emergency department patients who stay more than 6 hours contribute to crowding.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Henneman
authors.forename: Brian H
authors.initials: BH
authors.lastname: Nathanson
authors.forename: Haiping
authors.initials: H
authors.lastname: Li
authors.forename: Howard A
authors.initials: HA
authors.lastname: Smithline
authors.forename: Fidela S J
authors.initials: FS
authors.lastname: Blank
authors.forename: John P
authors.initials: JP
authors.lastname: Santoro
authors.forename: Ann M
authors.initials: AM
authors.lastname: Maynard
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Provost
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Henneman
mesh_terms: 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