Objectives: The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction. Methods:The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press-Ganey patient satisfaction surveys over a 2-year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization.Results: A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization.Conclusions: A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction. ACADEMIC EMERGENCY MEDICINE 2008; 15:825-831 ª 2008 by the Society for Academic Emergency MedicineKeywords: emergency department crowding, overcrowding, patient satisfaction, hallway, boarding, crowding P atient satisfaction data are used by emergency department (ED) administrators to track aggregate data over time, study interventions, assess individual physician performance, and construct financial incentive plans.1,2 A recent study identified six elements of emergency care associated with poor satisfaction: 1) not receiving help when needed, 2) a poorly explained problem, 3) not being told about waiting times, 4) not being told when to resume normal activities, 5) not having test results explained, and 6) not understanding when to return to the ED.3,4 While many elements of satisfaction are under provider control, many elements of ED care are difficult for an individual provider to improve, such as waiting time, boarding time, use of hallway treatment space, and overall levels of ED crowding that might reduce staff availability and impede ancillary services such as radiology and laboratory results. 5-11Despite the challenges of obtaining reliable and valid data, measurement of patient satisfaction is recognized by providers and regulators as vital to quality assurance and improvement.12,13 Satisfied patients are more likely to be compliant with their medications, return for continuing medical care, and communicate more effectively with their physicians.14-16 Patient satisfaction itself has been prop...

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