Objectives Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. Methods This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained from either the electronic health record or administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. Results The mean daily adult volume was 128 (SD ±14) patients before expansion, and 145 (SD ±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion, vs 8.3% after expansion (difference 0.6%, 95% CI = −0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference 20 hours, 95% CI = 8 to 32 hours). After adjusting for daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing, the decrease in patients who LWBT was not independently associated with ED expansion (p = 0.053). After adjusting for ED admissions, ED intensive care unit admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). Conclusions An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does not appear to be an adequate solution to ED crowding.

Hematologic and oncologic emergencies are an uncommon reason for people to present to the emergency department (ED), but when they do, it is important to know how to diagnose and treat these conditions because many of them are life threatening. Whether it is bleeding due to conditions such as hemophilia, von Willebrand’s disease, warfarin use, or dangerous conditions related to cancer such as tumor lysis syndrome or neutropenic fever, knowing the basics will help you manage these patients and also ace the standardized tests. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of these hematologic and oncologic emergencies.