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Does ED overcrowding affect outcomes or costs?

Does ED overcrowding affect patient outcomes or costs?

This study from Annals Emergency Medicine (.pdf) suggests so.

However, the study used times that hospital was on ambulance diversion as a measurement of overcrowding.  When a hospital diverts ambulances, that action may demonstrate overcrowding or may also be due to CT scanner being down or other non-volume-related reasons. And just because a hospital is not on diversion doesn’t mean that there aren’t beds lined up in the hallways to cope with overcrowding. So the study is trying to draw associations between metrics that may be only marginally related.
In addition, the study excluded many rural hospitals that did not keep ambulance diversion data. There are many studies showing that mortality in rural areas is higher than mortality in urban areas. Had rural hospitals been included in the study data, it is conceivable that the rural hospitals which tend not to go on bypass may have decreased or eliminated the difference in death rates between “overcrowded” times and “normal” ED volumes.
I certainly don’t agree with the authors that their data “support the perception of ED crowding as a marker of poor quality of care.” I’m all for decreasing ED overcrowding and I agree that ED overcrowding should be viewed as an important public health priority … but using cost, mortality, and length of stay as measures of “quality” care? Seriously?
That’s the Kool-Aid that CMS is trying to get us to drink. Sorry, I’m not thirsty.

Just because you call a pig a cat doesn’t mean it’s going to start meowing.

Watch all the unintended consequences that occur if we adopt cost, deaths, and length of stay as surrogates for “quality.”


  1. If you think that the patients in the ER are getting the nursing attention they may need from the nurses when we are bursting at the seams or when we are down nurses, you are kidding yourself.

  2. You forgot to mention the most flawed and potentially most costly quality indicator of them all, the one that’s based on patient satisfaction. That’s the Kool-Aid that I’ll never, ever drink no matter how hard the Stepford-inspired Studer-Bots try to enticed me into drinking it!

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