Time of Day Affects Emergency Department Throughput

Objectives: Emergency department (ED) overcrowding is a global phenomenon that negatively impacts quality of care.Prior studies have shown hospital type, such as teaching vs nonteaching, to play a role in ED throughput.The purpose of this article was to evaluate shift timing on ED patient throughput efficiency to identify areas for improvement.Methods: All trauma patients seen at our teaching level I trauma center from January 2018 through December 2024 were included in the study.Patient demographics, injury profile, and timeline of treatment interventions were collected.Timing of initial imaging, door-to-blood, and total ED length of stay (LOS) was compared for patients arriving at different shifts: morning (06:01-12:00), afternoon (12:01-18:00), evening (18:01-00:00), and overnight (00:01-06:00).Patients who were transferred in with a completed workup were excluded.Results: A total of 26,109 trauma patients were evaluated during the study period.Patients arriving in the morning shift had the slowest time from door-to-blood, while patients arriving in the evening shift had the fastest door-to-blood time (14.7 vs 9.9 minutes, p < 0.001).Patients arriving in the evening shift had the shortest ED LOS (305 minutes, p < 0.001).Patients in the overnight shift had the shortest time interval to imaging (53.8 minutes, p < 0.001).Despite the differences in throughput efficiency, there was no difference in mortality during different shifts.Conclusion: Shift-specific variations in ED throughput demonstrate opportunities to optimize resource allocation.The evening and overnight shifts performed more efficiently in moving patients to imaging and initiating blood transfusions in those who needed them.The morning shift performed least efficiently in ED LOS and blood transfusion times.Identifying factors contributing to these differences could improve ED operations and patient outcomes.