ArticleHealth services research2023
Association of emergency department crowding with inpatient outcomes.
Article in Health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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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.
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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.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Impact of Urban Hospital Closures on Surrounding Communities: A Systematic Review.Journal of general internal medicine · 2026Pooled it
- Emergency department crowding in the modern era: a systematic review (2018-2025).Clinical and experimental emergency medicine · 2026Pooled it
- Digital Order System Redesign in Emergency-to-Intensive Care Unit Admissions: Prospective Observational Study.JMIR formative research · 2026Observational
- A data-driven digital twin of emergency department flow to quantify congestion dynamics and test operational resilience.Internal and emergency medicine · 2026Article
- Daily, weekly, and monthly dynamics of crowding in emergency department of university clinical centre Serbia: a one-year analysis of NEDOCS score.International journal of emergency medicine · 2026Article
- Interregional reimbursement reform in China lowers administrative barriers to healthcare utilization.Communications medicine · 2026Article
- On Call or On Demand? Trends in Continuous Service Availability in California Emergency Departments, 2004-2024.Journal of general internal medicine · 2026Article
- National landscape of pediatric and adult inpatient sickle cell disease care.Blood advances · 2026Article
- Assessing the Impact of External and Internal Factors on Emergency Department Overcrowding.Healthcare (Basel, Switzerland) · 2025Article
- Shortening emergency department length of stay: Fast track, short-stay unit and acute medical unit.Exploratory research in clinical and social pharmacy · 2025Review
- Racial and ethnic disparities in emergency department transfers to public hospitals.Health services research · 2024Article
- Article
- Improvements to emergency department length of stay and user satisfaction after implementation of an integrated consult order.Journal of the American College of Emergency Physicians open · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo examine the association of higher emergency department (ED) census with inpatient outcomes on the day of discharge (inpatient length of stay, in-hospital mortality, ED revisits, and readmissions). DATA SOURCES AND STUDY
settingAll-payer ED and inpatient discharge data and hospital characteristics data from all non-federal, general, and acute care hospitals in the state of California from October 1, 2015 to December 31, 2017. STUDY
designIn retrospective data analysis, we examined whether ED census was associated with inpatient outcomes for all inpatients, including those not admitted through the ED. The main predictor variable was ED census on day of discharge, categorized based on hospital year and day of week. Separate linear regression models with robust SEs and hospital fixed effects examined the association of ED census on inpatient outcomes (length of stay, 3-day ED revisit, 30-day all-cause readmission, in-hospital mortality), controlling for patient and visit-level factors. We stratified analyses by whether admission was elective or unscheduled. EXTRACTION
methodsInpatient discharges in non-federal, general medical hospitals with EDs. PRINCIPAL
findingsWe examined 5,784,253 discharges. The adjusted model showed that, compared to when the ED was below the median, higher ED census on the day of discharge was associated with longer inpatient length of stay, lower readmissions, and higher in-hospital mortality (90th percentile for length of stay: +0.8% [95% confidence interval, CI: +0.6% to +1.1%]; readmissions: -0.59 percentage points [or -5.6%] [95% CI: -0.0071 to -0.0048]; mortality: +0.14 percentage points [or +5.4%] [95% CI: +0.0009 to +0.0018]). [Correction added on 18 November 2022, after first online publication: '[odds rato, OR -5.6%]' and '[OR +5.4%]' of the preceding sentence have been corrected to '[or -5.6%]' and '[or +5.4%]', respectively, in this version.] Results for length of stay were primarily driven by patients with elective admissions, while results for readmissions and in-hospital mortality were primarily driven by patients with unscheduled admissions.
conclusionsThis study suggests that ED crowding may affect inpatients throughout the hospital, even patients who are already admitted to the hospital.
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