Emergency Department Access

Emergency department (ED) crowding and boarding are increasingly problematic for the U.S. health care system. Research has shown that hospitals with higher levels of crowding and boarding have consistently poorer quality and outcomes (National Quality Forum, 2012, Morley et al., 2018). Research has shown that ED wait times are associated with longer length of stays, increased morbidity and mortality, patients leaving the ED without being seen, negative patient satisfaction, and increased costs (Vermeulen et al., 2014, Shen et al., 2018).

There is a growing emphasis on adopting interventions that have proven effective for decreasing ED wait times and crowding. Research, however, indicates that relatively few hospitals report implementing known strategies for decreasing ED wait times (Rabin et al., 2012, Tabriz et al., 2019).

Analyzing the Data

The purpose of this analysis is to identify if there is an association between timely and effective care measures. Specifically, this scenario will answer the following:

  • Do hospitals that have greater wait times to be seen by a qualified medical professional in the ED also have a higher proportion of patients that leave the ED before being seen?

  • Do hospitals with greater wait times to be seen by a qualified medical professional in the ED also have higher wait times before ED patients are admitted as an inpatient?

In addition, further analysis will be conducted to determine if these associations exist for counties or states. And finally, the implications of such observed associations will be revealed.

This data is also available in a text-based table format. This alternate format also provides hospital-specific data.

Tutorial: Using the Data

Data Sources

Hospital Compare - Hospital General Information (data released July, 2020)

Hospital Compare - Timely and Effective Care Measures (data released July, 2020)

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviated name of the state where the hospital is located.

County: The name of the county where the hospital is located. County names are listed as provided on the U.S. Census Bureau's list of 2019 FIPS Codes for Counties and County Equivalent Entities.

Hospital: The name of the hospital.

Hospital Type: The type of hospital, which includes acute care hospitals, critical access hospitals (CAHs), and children's hospitals.

Hospital Ownership: The ownership type for the hospital, which includes: Voluntary non-profit - Private, Government - Federal, Proprietary, Government - Hospital District of Authority, Government - Local, Voluntary non-profit - Other, Voluntary non-profit - Church, Physician, Government - State and Tribal.

Measure Name: The name of the timely and effective care measure. The measures include the following:

  • ED_2b: Average (median) time patients spent in the emergency department, after the doctor decided to admit them as an inpatient before leaving the emergency department for their inpatient room A lower number of minutes is better. A lower value is desired.

  • OP_18b: Average (median) time patients spent in the emergency department before leaving from the visit. A lower value is desired. 

  • OP_22: Percentage of patients who left the emergency department before being seen. A lower value is desired.

Measure Score: The numeric score for the measure which may represent the average time in minutes or a proportion depending on the measure. See Measure Name for more information on how to interpret the score for each measure. The reporting period for the ED_2b and OP_18b measures is July 1, 2018 through June 30, 2019 and for OP_22 measure is January 1, 2018 through December 31, 2018.

Denominator: The sample size used to determine the score for the measure.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,009,121 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.