The effect of hospital bed occupancy on throughput in the pediatric emergency department

Ann Emerg Med. 2009 Jun;53(6):767-76.e3. doi: 10.1016/j.annemergmed.2008.11.024. Epub 2009 Feb 28.


Study objective: Although it has been suggested that high hospital occupancy leads to emergency department (ED) overcrowding and impedes ED throughput, there are limited data defining this relationship. The objective of this study is to examine whether high inpatient hospital occupancy negatively affects throughput in a pediatric ED.

Methods: This cross-sectional analysis evaluated patient visits to an urban pediatric ED and hospital occupancy rates. Data were collected from a 347-bed pediatric tertiary care hospital in Boston, MA, between January and December 2006. Primary outcome measure was ED length of stay; secondary outcomes were percentages of patients who left without being seen or had a hallway bed used for treatment.

Results: Throughout the study period, there were 56,335 patient visits to the pediatric ED; 9,687 (17%) patients were hospitalized. High hospital occupancy directly correlated with longer length of stay for all patients treated in the ED. When inpatient occupancy was at or more than 80% capacity, every 5% increase in hospital occupancy was associated with an increase in length of stay of 17.7 minutes for discharged patients (95% confidence interval [CI] 2.2 to 33.2 minutes) and 34.3 minutes for admitted patients (95% CI 11.4 to 57.2 minutes). With the same 5% increase in inpatient occupancy, there were increases in the odds of either a patient leaving without being seen (odds ratio 1.21; 95% CI 1.12 to 1.31) or being treated in a hallway bed (odds ratio 1.18; 95% CI 1.15 to 1.22).

Conclusion: High hospital occupancy has a significant and quantifiable negative influence on ED throughput, affecting patients both discharged and hospitalized.

MeSH terms

  • Bed Occupancy*
  • Cross-Sectional Studies
  • Emergency Service, Hospital / organization & administration*
  • Hospitals, Pediatric / organization & administration*
  • Hospitals, Urban / organization & administration
  • Humans
  • Length of Stay*
  • Patient Admission*
  • Time Factors