ArticleBMJ (Clinical research ed.)2011
Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada.
Article in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05392829 (Reorientation of Tripped Patients 4 and 5 in Emergency Department to the City Medicine), which is not on this map. Cited by 276 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Reorientation of Tripped Patients 4 and 5 in Emergency Department to the City Medicine
Who cites it
276 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Diagnostic accuracy of point-of-care ultrasound in adult non-traumatic emergency medicine: an umbrella review.BMC medicine · 2026Pooled it
- Safety and Efficacy of Digital Check-in and Triage Kiosks in Emergency Departments: Systematic Review.Journal of medical Internet research · 2025Pooled it
- Reducing outpatient wait times through telemedicine: a systematic review and quantitative analysis.BMJ open · 2025Pooled it
- Nonspecific complaints in the emergency department - a systematic review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2020Pooled it
- Emergency department crowding: A systematic review of causes, consequences and solutions.PloS one · 2018Pooled it
- Machine learning for risk stratification in the emergency department (MARS-ED): a randomized controlled trial.Nature communications · 2025Trial
- Health Care Resource Utilization for Patients With Suspected Myocardial Infarction: A Secondary Analysis of the RACE-IT Randomized Clinical Trial.JAMA network open · 2025Trial
- Role of point-of-care ultrasound study in early disposition of patients with undifferentiated acute dyspnea in emergency department: a multi-center prospective study.Journal of ultrasound · 2022Trial
- Role of Point-of-Care Testing in Reducing Time to Treatment Decision-Making in Urgency Patients: A Randomized Controlled Trial.The western journal of emergency medicine · 2020Trial
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- Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III).Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Trial
- IMPACT: Integrated Model For Patient Acuity, Care, And Triage Efficiency In Emergency Department.Journal of medical systems · 2026Article
- Person-centred emergency care: translation and cross-cultural validation of the Australian Emergency Department Patient-Reported Experience Measure (ED PREM) in the Netherlands.Emergency medicine journal : EMJ · 2026Article
- Service use and program-level impacts of a collaborative hospital-community emergency department diversion program for people experiencing alcohol and opioid intoxication.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
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- Emergency physician burnout and attrition in Canada: a longitudinal study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Article
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216 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events.
designPopulation based retrospective cohort study using health administrative databases. Setting High volume emergency departments in Ontario, Canada, fiscal years 2003-7.
participantsAll emergency department patients who were not admitted (seen and discharged; left without being seen). OUTCOME MEASURES: Risk of adverse events (admission to hospital or death within seven days) adjusted for important characteristics of patients, shift, and hospital.
results13,934,542 patients were seen and discharged and 617,011 left without being seen. The risk of adverse events increased with the mean length of stay of similar patients in the same shift in the emergency department. For mean length of stay ≥ 6 v <1 hour the adjusted odds ratio (95% confidence interval) was 1.79 (1.24 to 2.59) for death and 1.95 (1.79 to 2.13) for admission in high acuity patients and 1.71 (1.25 to 2.35) for death and 1.66 (1.56 to 1.76) for admission in low acuity patients). Leaving without being seen was not associated with an increase in adverse events at the level of the patient or by annual rates of the hospital.
conclusionsPresenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.