Current research suggests that factors external to the ED, such as hospital bed availability, laboratory turnaround, specialist consultation availability and elective surgery schedules may be more important in determining ED throughput than internal bottlenecks such as ED staff availability and bed shortages [2-4]. The 2001 position statement on ED Overcrowding by the Canadian Association of Emergency Physicians stated that Inhibitors,research,lifescience,medical hospital overcrowding was the primary cause of ED overcrowding [7]. That is, patients

who should be admitted are held (boarded) in the ED because there are no hospital beds available, and this in turn uses ED resources and prevents other patients from being treated in a timely manner in the ED. This position has been echoed by professional bodies in Australia, the USA and the UK [8-10]. In addition to the potential health impact of admission delays, there may be an economic impact [11-13]. Admission through the ED accounts Inhibitors,research,lifescience,medical for a sizable portion of all admissions to surgery and inpatient wards [6]. However, there is limited evidence on the health or economic Inhibitors,research,lifescience,medical impact of emergency department admission delays

in Canada. We sought to determine the impact of emergency department admission delays on two outcomes: inpatient (IP) LOS and total IP cost. Methods Study design and patient population This was a secondary analysis using data from London Health Sciences Centre, a large multisite acute-care teaching hospital in Ontario, Canada with two adult EDs. The data was contained Inhibitors,research,lifescience,medical in three administrative databases: The National Ambulatory Care Reporting System (NACRS), which captures information on ED visits; the Discharge Abstract Database (DAD), which stores information on inpatient

stays; and the hospital’s case costing database, which records all resources consumed Inhibitors,research,lifescience,medical by patients during their hospital visits. Eligible patients were all persons ≥ 18 years of age who selleck chemicals presented to either of the EDs between April 1 2006 and March 30 2007 and who were subsequently admitted to the operating room (OR), ICU, or an inpatient ward. found This patient population was selected by identifying patient IDs that were present in both the NACRS and the DAD for the same hospital encounter. Records were excluded when there were linking algorithm errors, unmatched ED or hospital stays, or a negative LOS for either the ED or the inpatient stay. Clinical information was obtained from the available data fields in the NACRS and the DAD. Cost information was obtained by linking this cohort with the case costing database. All costs are in 2006 Canadian dollars.