The impact of delays to admission from the emergency department on inpatient outcomes

We conducted a retrospective analysis of 13,460 adult (≥ 18 yrs) ED visits between April 1 2006 and March 30 2007 at a tertiary care teaching hospital with two ED sites in which the mode of disposition was admission to ICU, surgery or inpatient wards. We defined ED Admission Delay as ED time to decision to admit > 12 hours. The primary outcomes were IP LOS, and total IP cost.Approximately 11.6% (n = 1558) of admitted patients experienced admission delay. In multivariate analysis we found that admission delay was associated with 12.4% longer IP LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We estimated the cumulative impact of delay on all delayed patients as an additional 2,183 inpatient days and an increase in IP cost of $2,109,173 at the study institution.Delays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays.Emergency Department ED overcrowding and delays in ED throughput have several important consequences, such as boarding of admitted patients in the ED, longer hospital stays, the inability of patients to gain access to appropriate hospital beds, lost opportunities to treat patients due to ambulance diversion, and "left without being seen" (LWBS) patients [1-6].Current research suggests that factors external to the ED, such as hospital bed availability, laboratory turnaround, specialist consultation availability and elective surgery schedules may be more important in determining ED throughput than internal bottlenecks such as ED staff availability and bed shortages [2-4]. The 2001 position statement on ED Overcrowding by the Canadian Association of Emergency Physicians stated that hospital overcrowding was the primary cause of ED overcrowding [7]. That is, patients who should be admitted are held (boarded) in the ED because