IMPACT OF EMERGENCY DEPARTMENT OVERCROWDING ON PATIENT OUTCOMES AT A TERTIARY CARE TEACHING HOSPITAL

Abstract

Background: Emergency department (ED) overcrowding may delay care and adversely affect patient outcomes, particularly in high-volume tertiary hospitals. Objective: To evaluate the association between ED overcrowding, care-process delays, and adverse patient outcomes at a tertiary care centre. Methods: This prospective observational cohort study included 600 consecutive ED patients. Overcrowding was defined as an occupancy ratio >100% at arrival. Outcomes included time to physician assessment, time to treatment, ED length of stay, premature departure, ICU transfer, in-hospital death, 72-hour revisit, and a composite adverse outcome. Multivariable models adjusted for demographic characteristics, triage category, comorbidity, arrival mode, shift, and NEWS2 score. Results: Overcrowding occurred in 340 patients (56.7%). It was associated with adjusted median delays of 20.5 minutes to physician assessment, 25.6 minutes to treatment, and 53.5 minutes in ED length of stay (all p<0.001). The composite adverse outcome was more frequent during overcrowding (25.3% vs 15.4%; risk ratio 1.64, 95% CI 1.17–2.31). Overcrowding remained independently associated with the composite outcome (adjusted odds ratio 1.91, 95% CI 1.20–3.03) and doubled the risk of leaving early. Conclusion: ED overcrowding was associated with delayed care, prolonged stay, premature departure, and increased overall adverse outcomes.