A widespread and increasing level of overcrowding in emergency department in the United States is putting patient safety and access to care at risk, two new studies show.

Researchers examined, respectively, the progression in recent years of two measures of emergency department (ED) function and hospital capacity: boarding time—or how long patients remain in the ED after physicians have determined they should be admitted to the hospital—and how often patients leave the ED before receiving care.

The findings help characterize the bigger issues that underlie ED crowding, the researchers say, and show that the issue worsened during the COVID-19 pandemic. For the studies, the researchers used methods that yield more timely assessments of these key indicators, which historically have been hard to come by.

“This is not an ED management issue,” says Arjun Venkatesh, an associate professor of emergency medicine at Yale School of Medicine and an author of the studies. “These are indicators of overwhelmed resources and symptoms of deeper problems in the health care system.”

The studies (study 1, study 2) appear in JAMA Network Open.

During the 1980s, ED crowding emerged as an issue of national concern. The problem has only gotten worse in the decades since, however, with negative effects for patients and hospital staff alike.

For patients, studies have found that ED crowding is correlated with discomfort, reduced privacy, treatment delays, and higher risk of prolonged disease and death. ED crowding also leads to increased violence toward staff, greater clinician and nurse turnover, and high rates of burnout. A recent study found nearly 63% of surveyed US physicians experienced burnout in 2021.

In one of the new studies, researchers found that boarding times—or the amount of time patients were kept in the emergency department after clinicians had determined they should be admitted—were related to hospital occupancy rates, or the percentage of staffed inpatient beds that are occupied. The Joint Commission, an independent national health care accrediting body, has recommended that boarding time not exceed four hours.

Read the full article about overcrowded emergency rooms at Futurity.