Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Amongst patients presenting to the emergency department with acute asthma exacerbations, crowding negatively impacted the care provided in all triage groups.

Evidence Rating Level: 2 (Good)

Crowding in the emergency department, a state where demand for care services exceeds the capacity of providers, has been a longstanding healthcare concern. Studies have demonstrated that crowding can lead to poor patient outcomes, incomplete patient care, increased health care costs, as well as higher mortality. These delays on time-sensitive interventions can impact patients presenting with acute asthma exacerbations; although, literature investigating this association is scarce. In this retrospective cohort study, 1 264 025 adults presenting with acute asthma exacerbations to a hospital in Alberta, Canada were examined. Emergency department (ED) triage was determined based on the Canadian Triage and Acuity Scale (CTAS) which is employed in most Canadian EDs. The primary outcomes assessed in this paper include length of stay and physician initial assessment (PIA) time. The results showed that emergency department crowding affected all triage groups. However, higher acuity patients with acute asthma were less impacted by ED crowding compared to mild or moderate asthma presentations. Crowding was associated with a 26-minute increase in wait time for the high acuity group, 54 minutes in the moderate acuity group, and 61 minutes in the low acuity group (95%CI 24-28; 95%CI 53-55; 95%CI 59-63, respectively). Additionally, crowding and delays in physician initial assessment time increased risk of admission for the higher acuity group. In conclusion, while emergent care provided in all three triage groups was impacted by ED crowding, moderate and low acuity groups were affected more significantly. While this study does have a large sample size and robust data, it still has some limitations. Firstly, information regarding the asthma management and control of each individual patient is not known, and variations in pre-existing asthma severity may impact these results. As well, as this study was only conducted in Alberta, these results cannot be generalized to a wider population. Nevertheless, this paper provides strong insight into the negative impacts of emergency room crowding on patient outcomes. Further research and strategies mitigating crowding in the ED are essential to improve patient care.

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