Access to Care

"Overcrowding in the Nation’s Emergency Departments: Complex Causes and Disturbing Effects"
(2000) Annals of Emergency Medicine
Eight key effects of ED crowding are: prolonged pain and suffering, public safety risk, ambulance diversions, dissatisfied patients, violence, decreased physician productivity, miscommunication, and negative teaching effects in academic medical centers.

"Emergency Department Crowding and Thrombolysis Delays in Acute Myocardial Infarction"
(2004)Annals of Emergency Medicine.
ED crowding is associated with increased door-to-needle times for patients with suspected acute myocardial infarction and may represent a barrier to improving cardiac care in emergency departments. High network crowding was associated with a 40% increase in the odds of a major door-to-needle time greater than 60 minutes. It was also associated with a 5.8 minute increase in the median door-to-needle time compared with conditions of no network crowding. This delay has been estimated and expected to result in 7 additional deaths per 1,000 patients treated.

"The Financial Burden of Emergency Department Congestion and Hospital Crowding for Chest Pain Patients awaiting Admission"
(2005)Annals of Emergency Medicine.
This research study found that time spent in the ED by chest pain patients did not worsen patient outcomes, reduce total hospital length of stay, reduce hospital costs, or increase hospital revenues. However, significant opportunity costs were incurred. Lost potential revenue from extended ED length of stay for low-risk chest pain patients was estimated at $168,300 per year. Extrapolating these observations to the hospital’s annual ED census and adjusting for the variable pattern of ED utilization suggests an annual opportunity loss of greater than $1.74 million.