title: National ED crowding and hospital quality: results from the 2013 Hospital Compare data.
abstract: OBJECTIVE
  We explored Hospital Compare data on emergency department (ED) crowding metrics to assess characteristics of reporting vs nonreporting hospitals, whether hospitals ranked as the US News Best Hospitals (2012-2013) vs unranked hospitals differed in ED performance and relationships between ED crowding and other reported hospital quality measures.
  
  
  METHODS
  An ecological study was conducted using data from Hospital Compare data sets released March 2013 and from a popular press publication, US News Best Hospitals 2012 to 2013. We compared hospitals on 5 ED crowding measures: left-without-being-seen rates, waiting times, boarding times, and length of stay for admitted and discharged patients.
  
  
  RESULTS
  Of 4810 hospitals included in the Hospital Compare sample, 2990 (62.2%) reported all ED 5 crowding measures. Median ED length of stay for admitted patients was 262 minutes (interquartile range [IQR], 215-326), median boarding was 88 minutes (IQR, 60-128), median ED length of stay for discharged patients was 139 minutes (IQR, 114-168), and median waiting time was 30 minutes (IQR, 20-44). Hospitals ranked as US News Best Hospitals 2012 to 2013 (n=650) reported poorer performance on ED crowding measures than unranked hospitals (n=4160) across all measures. Emergency department boarding times were associated with readmission rates for acute myocardial infarction (r=0.14, P<.001) and pneumonia (r=0.17, P<.001) as well as central line-associated bloodstream infections (r=0.37, P<.001).
  
  
  CONCLUSIONS
  There is great variation in measures of ED crowding across the United States. Emergency department crowding was related to several measures of in-patient quality, which suggests that ED crowding should be a hospital-wide priority for quality improvement efforts.
authors.affiliation: Department of Health Policy The George Washington University School of Public Health and Health Services, Washington, DC. Electronic address: petermmullins@gmail.com.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mullins
authors.affiliation: Departments of Health Policy and Emergency Medicine The George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D003441:Crowding; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists