Original Contribution National ED crowding and hospital quality: results from the 2013 Hospital Compare data Peter M. Mullins, MA, MPH a, ⁎, Jesse M. Pines, MD, MBA, MSCE b a Department of Health Policy The George Washington University School of Public Health and Health Services, Washington, DC b Departments of Health Policy and Emergency Medicine The George Washington University School of Medicine and Health Sciences, Washington, DC abstract article info Article history: Received 27 November 2013 Received in revised form 23 January 2014 Accepted 4 February 2014 Objectives: We explored Hospital Compare data on emergency department (ED) crowding metrics to assess characteristics of reporting vs nonreporting hospitals, whether hospitals ranked as the US News Best Hospitals (2012-2013) vs unranked hospitals differed in ED performance and relationships between ED crowding and other reported hospital quality measures. Methods: An ecological study was conducted using data from Hospital Compare data sets released March 2013 and from a popular press publication, US News Best Hospitals 2012 to 2013. We compared hospitals on 5 ED crowding measures: left-without-being-seen rates, waiting times, boarding times, and length of stay for admitted and discharged patients. Results: Of 4810 hospitals included in the Hospital Compare sample, 2990 (62.2%) reported all ED 5 crowding measures. Median ED length of stay for admitted patients was 262 minutes (interquartile range [IQR], 215- 326), median boarding was 88 minutes (IQR, 60-128), median ED length of stay for discharged patients was 139 minutes (IQR, 114-168), and median waiting time was 30 minutes (IQR, 20-44). Hospitals ranked as US News Best Hospitals 2012 to 2013 (n = 650) reported poorer performance on ED crowding measures than unranked hospitals (n = 4160) across all measures. Emergency department boarding times were associated with readmission rates for acute myocardial infarction (r = 0.14, P b .001) and pneumonia (r = 0.17, P b .001) as well as central line–associated bloodstream infections (r = 0.37, P b .001). Conclusions: There is great variation in measures of ED crowding across the United States. Emergency department crowding was related to several measures of in-patient quality, which suggests that ED crowding should be a hospital-wide priority for quality improvement efforts. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Emergency department (ED) crowding is a common issue in many hospitals in the United States and around the world [1]. Nationally, the number of ED visits is increasing faster than population growth, whereas patients presenting to EDs receive more resource intensive care than in previous years [2,3]. Increased ED use has negative effects on a variety of ED processes and patient-oriented outcomes. Emergency department crowding is associated with poorer pain care [4], delayed antibiotics in pneumonia [5,6], increased in-hospital mortality [7,8], and an increased likelihood of patients leaving without being seen [9-11]. Recently, there has been an increased focus on quality measurement and improvement in US hospitals. Organizations including governmen- tal agencies, such as the Center for Medicare and Medicaid Services (CMS) and nongovernmental entities, such as the National Quality Forum, have supported quality measures, including several measures of ED crowding, with the goal of improving care. Measurement data are made publicly available on a Department of Health and Human Services (HHS) website called Hospital Compare (www.medicare.gov/ hospitalcompare/) and includes data from a variety of sources, including patient-completed surveys, readmission, complication, and mortality rates in hospitals and both timeliness and effectiveness measures. In March 2013, Hospital Compare publicly released ED crowding data for thousands of hospitals for the first time in the United States in the form of several measures: left-without-being-seen rates, separate measures of ED length of stay for discharged and admitted patients, and ED boarding times and waiting times. In this study, we explored Hospital Compare data related to ED crowding measures in US hospitals in a variety of ways. First, we assessed whether there were measurable hospital factors associated with hospitals that reported the measures. Second, we investigated whether an assessment of hospital quality in the popular press (US News Best Hospitals 2012-2013) was associated with differences in ED crowding. Finally, we explored the relationship among crowding measures and the relationship between ED crowding measures and other quality metrics, specifically process and outcome measures. American Journal of Emergency Medicine 32 (2014) 634–639 ⁎ Corresponding author. E-mail address: petermmullins@gmail.com (P.M. Mullins). http://dx.doi.org/10.1016/j.ajem.2014.02.008 0735-6757/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem