The short answer is that it might. While it may not be surprising to you that ED crowding is detrimental to overall patient care, it may surprise you that it could be linked to inpatient mortality. At least a few studies have been looking in that direction.


A 2013 study with almost 1 million ED visits to 187 California hospitals (Sun et al. 2013) found that periods of high ED crowding were associated with increased inpatient mortality, as well as increased length of stay and cost for admitted patients. Another 2015 study (Jo et al. 2015), looking specifically at critically ill patients, found that ED crowding was associated with increased mortality in critically ill patients who were admitted through the ED. A 2015 study conducted in Belgium (Verelst et al. 2015) found that ED crowding was associated with higher inpatient costs, however did not increase mortality.


Solutions for ED crowding have been posed and research is continually ongoing. As a clinician, you should remain cognizant that ED crowding may indirectly affect patients admitted to the hospital. For your practice, keep a focus on rapid but appropriate disposition. In addition, during periods of heavy crowding, if a patient can follow up outpatient with ED return precautions, it may be more appropriate for their care and for the care of other patients already in the hospital. Lastly, when boarding a significant number of patients, transfer to another hospital for admission may result in better patient outcomes.




Bernstein, Steven L., and Brent R. Asplin. “Emergency department crowding: old problem, new solutions.” Emergency medicine clinics of North America 24.4 (2006): 821-837.


Derose, Stephen F., et al. “Emergency department crowding predicts admission length-of-stay but not mortality in a large health system.” Medical care 52.7 (2014): 602-611.


Jo, Sion, et al. “ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study.” The American journal of emergency medicine 33.12 (2015): 1725-1731.


Sun, Benjamin C., et al. “Effect of emergency department crowding on outcomes of admitted patients.” Annals of emergency medicine 61.6 (2013): 605-611.


Verelst, Sandra, et al. “Emergency Department Crowding in Relation to In-hospital Adverse Medical Events: A Large Prospective Observational Cohort Study.” The Journal of emergency medicine 49.6 (2015): 949-961.

June 2024