J Korean Soc Emerg Med.  2020 Aug;31(4):420-429.

The impact of emergency department expansion on crowding and patient flow

  • 1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Emergency Nursing, Yonsei University Health System, Seoul, Korea
  • 3Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea


Overcrowding in the emergency department (ED) has been a long-standing global problem, but has yet to be resolved. This study was undertaken to investigate whether expansion of the ED can affect overcrowding.
This was a retrospective study comparing two 10-month periods: before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The ED expansion included expansion of the ambulatory area and establishment of a 25-bedded emergency ward dedicated to patients admitted through the ED.
Comparing the two study periods, we noted an increase in the number of patients visiting the ED, from 77,078 to 87,027. Moreover, the proportion of patients who returned home untreated significantly decreased from 11.5% to 0.9% (P<0.001). The number of adult patients increased from 40,814 to 60,720; in particular, the number of ambulatory patients increased from 18,648 to 42,944. Conversely, waiting time for X-ray and computed tomography increased (10.0 to 17.0 minutes, and 35.0 to 48.0 minutes, respectively). Other areas with increased time duration include median ED length of stay of total patients (193.0 minutes to 205.8 minutes), and time from consultation to admission decision (122.3 to 161.4 minutes). However, the boarding time decreased from 239.2 to 190.9 minutes.
The ED expansion allowed more patients to be treated, and the boarding time of admitted patients was reduced through operation of the emergency ward. However, due to increase in the number of visiting patients, the time required for medical treatment increased concurrently.


Emergency service; Hospital; Crowding; Length of stay; Patient admission
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