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Although crowding is a problem at hospitals across the U.S. and Canada, few studies have shown negative effects of crowding on patient care. In a retrospective cohort study of 226,534 patient visits to four U.S. emergency departments during 1 year, the authors quantified the effect of crowding on ED waiting room time (time from registration to room placement), treatment time (time from room placement to disposition decision), and boarding time. The four EDs differed significantly in baseline patient acuity, admission rates, and proportions of uninsured patients, but annual ED volume and median ED length of stay (LOS) were similar.
After adjustment for clinical characteristics, crowding significantly increased waiting room time and boarding t…