Crowded Emergency Rooms May Increase Risk of Death: Study

Individuals admitted to the hospital after visiting an overcrowded emergency room may face an increased risk of death, according to the findings of new research.  

Data on nearly 1 million patients visiting emergency departments were reviewed as part of the study, which found a 5% increase in the risk of death among patients admitted after treatment in a crowded emergency room. These patients also experienced an increase in the length of the hospital stay and admission cost of the visit.

The retrospective cohort analysis was published online in the Annals of Emergency Medicine December 10, examining information from patients admitted to 187 hospital emergency departments in California during 2007. The hospitals were all nonfederal, acute care hospitals.

Researchers identified those hospital admissions that occurred on days when ambulances were diverted from the hospital; a sign of crowded emergency rooms.

Nearly four percent of patients who died were admitted to hospitals on days when overcrowding occurred, leading researchers to determine that patient care quality is not at its peak when emergency rooms are crowded.

Researchers also found other effects of crowded emergency departments on patients. The study positively linked overcrowding to nearly 300 deaths, a total of more than 6,000 days stay in the hospital and $17 million in extra costs.

“We are suggesting that one reason for this association is, when you have a crowded hospital or emergency department, that the quality of care is not as good, that there are delays in diagnosis, there are delays in treatment, and all these things add up so that for a small set of patients this actually makes a difference in whether they survive or don’t survive,” said Dr. Benjamin Sun, co-author of the study and associate professor at Oregon Health & Science University.

The Agency for Healthcare Research and Quality (AHRQ) offers a guide to hospital emergency departments to help reduce emergency department over crowding and improve patient inflow.

AHRQ recommends hospital administrators identify the most likely causes or specific problems the department faces during overcrowding. By identifying the causes it is much easier to determine a course of action.

They also advocate examining what other emergency departments have done to improve patient flow and consider the hospital’s resources for additional staffing, financial or educational resources and leadership support. Hospitals are also advised to devise and test an emergency room strategy that works.

Some hospitals found it helpful to have patients who will be admitted to the hospital as an inpatient to wait in hallways, instead of emergency rooms, while waiting for a room. Other hospitals began posting emergency room wait times on a common bulletin board to keep patients informed and ensure elective procedures are scheduled throughout the week to ensure they do not outweigh emergency procedures on any given day.