Emergency department throughput, crowding, and financial outcomes for hospitals

Daniel A. Handel, Joshua A. Hilton, Michael J. Ward, Elaine Rabin, Frank L. Zwemer, Jesse M. Pines

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Emergency department (ED) crowding has been identified as a major public health problem in the United States by the Institute of Medicine. ED crowding not only is associated with poorer patient outcomes, but it also contributes to lost demand for ED services when patients leave without being seen and hospitals must go on ambulance diversion. However, somewhat paradoxically, ED crowding may financially benefit hospitals. This is because ED crowding allows hospitals to maximize occupancy with well-insured, elective patients while patients wait in the ED. In this article, the authors propose a more holistic model of hospital flow and revenue that contradicts this notion and offer suggestions for improvements in ED and hospital management that may not only reduce crowding and improve quality, but also increase hospital revenues. Also proposed is that increased efficiency and quality in U.S. hospitals will require changes in systematic microeconomic and macroeconomic incentives that drive the delivery of health services in the United States. Finally, the authors address several questions to propose mutually beneficial solutions to ED crowding that include the realignment of hospital incentives, changing culture to promote flow, and several ED-based strategies to improve ED efficiency.

Original languageEnglish
Pages (from-to)840-847
Number of pages8
JournalAcademic Emergency Medicine
Issue number8
StatePublished - Aug 2010


  • Crowding
  • Financial management
  • Hospitals
  • Outcome and process assessment (Health Care)


Dive into the research topics of 'Emergency department throughput, crowding, and financial outcomes for hospitals'. Together they form a unique fingerprint.

Cite this