Effects of emergency department overcrowding on admitted patient outcomes: A systematic review of etiology and risk

OBJECTIVE: To determine the effects of emergency department (ED) overcrowding on the following outcomes of admitted patients: mortality; hospital length-of-stay (LOS); time to antibiotic; time to thrombolysis; and time to analgesic. METHOD: Systematic review of etiology and risk including adult patients, aged 18 years or more, admitted to ED settings who were exposed to overcrowding. Search strategy ran in MedicLatina, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, SciELO, Banco de teses da CAPES, RCAAP, and OpenGrey. Assessment of risk of bias, data extraction, and synthesis were performed by two reviewers independently. RESULTS: Out of 3500 records, 30 fulfilled the inclusion criteria. The results of the studies show that overcrowding in ED contributes to an increase in mortality, longer LOS and delays in the administration of antibiotics and analgesics. No evidence was found that overcrowding influences time to thrombolysis. However, seven of the studies concluded that overcrowding was not associated with increased mortality. CONCLUSION: ED overcrowding has a negative impact on outcomes of admitted patients, highlighting its influence on the quality of care provided in ED settings. In future research, it is important to understand which factors contribute to overcrowding to create strategies to overcome this public health problem.