Study: Overcrowded EDs raise mortality rates

Overcrowded emergency departments (EDs) put patients’ lives at risk, increasing the likelihood of inpatient mortality by 5 percent, according to research published December by the Annals of Emergency Medicine.

Hospital-based Emergency Care: At the Breaking Point is the title of a 2006 Institute of Medicine publication that warned of the potential negative effects associated with a surge in ED overcrowding. Despite its call to action and a casual link between overcrowding and adverse outcomes, EDs treat more and more patients each year and it could be at their risk.

“Establishing a definitive relationship between ED crowding and subsequent mortality may motivate policymakers to address overcrowding as a top public health priority,” wrote lead author Benjamin C. Sun, MD, MPH, a medical professor at Oregon Health and Science University in Portland, along with his colleagues.

Researchers examined 995,379 ED admissions to 187 California hospitals with emergency facilities in 2007 using data collected from the Office of Statewide Hospital Planning and Development, and they developed a model to estimate overcrowding of EDs based on available information for ambulance diversion.

Outcomes considered included inpatient mortality rates, length of stay and costs. Researchers determined that ED overcrowding was associated with 5 percent greater odds of inpatient death, a 0.8 percent increase in length of stays and a 1 percent increase in costs, amounting to a total of approximately 300 deaths, 6,200 hospital days and $17 million.

Sun and his colleagues attributed the overcrowding problem in part to hospital practices that leave little room to accommodate for overflow. “Attempts to maximize inpatient bed occupancy have reduced the ability of hospitals to absorb new patients and increased the prevalence of admitted patients boarding in the ED.”

Growing evidence of ED overcrowding negative effects should push policymakers to take action against it. “Despite mounting evidence that ED crowding is a health delivery problem that reduces access to emergency care, results in worse quality of care, and leads to lower patient satisfaction, there have been few systematic actions to address the crisis of ED crowding,” Sun et al concluded. “Policymakers should heed the recommendations of the Institute of Medicine and address ED crowding as an important public health priority.”