Effect of ED Expansion on Overcrowding: Bigger Is Not Always Better

Overcrowding and boarding of admitted patients are virtually universal in emergency departments in the U.S. ED expansion is one potential “solution.” These authors compared diversion rates, ED volume, and waiting times during a 5-month period before (19,044 patient visits) and a 5-month period after (21,934 patient visits) expansion of a level I trauma center ED from 28 to 53 licensed beds.

The total number of ambulance diversions per month and the total time spent on diversion (the primary endpoints) did not change after expansion. Although mean daily ED volume increased by 29 patients (23%) after expansion, the number of admission holds increased by 67% (from 3 to 5 patients per hour), and patients waited 37% longer (from 3 to 4 hours) for…