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Load leveling as a strategy to enhance emergency department throughput
Monisha Dilip1, Huifeng Su2, Weiheng Zhang2
1Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA.
The American Journal of Emergency Medicine
|September 4, 2025
Summary
Load-leveling, transferring patients between hospital campuses, significantly reduces emergency department (ED) boarding times. This strategy improves patient flow and capacity within hospital systems facing ED crowding.
Area of Science:
- Health Services Research
- Hospital Operations Management
- Emergency Medicine
Background:
- Emergency Department (ED) crowding is a critical national healthcare issue.
- Patient load-leveling, transferring patients between hospital campuses, aims to redistribute capacity.
- The impact of load-leveling on ED throughput and operations requires thorough evaluation.
Purpose of the Study:
- To assess the effect of patient load-leveling on ED throughput from the transferred patient's viewpoint.
- To evaluate the operational benefits and drawbacks of load-leveling within a single health system.
- To analyze boarding times and inpatient length-of-stay for load-leveled patients.
Main Methods:
- Retrospective observational study of two EDs within a single health system.
- Analysis of 42,046 admissions, categorizing patients into load-leveled (transferred) or same-campus admitted groups.
- Primary outcomes: boarding times and inpatient length-of-stay; Secondary outcomes: ED throughput metrics.
Main Results:
- Load-leveled patients experienced significantly shorter boarding times (7.8 hours reduction).
- No significant difference in inpatient length-of-stay was observed between groups.
- Load-leveling reduced door-to-room times and the risk of patients leaving without being seen.
Conclusions:
- Load-leveling effectively decreases ED boarding times, enhancing capacity for incoming patients.
- This strategy serves as a valuable tool for hospital systems to improve overall patient throughput.
- Implementing load-leveling can mitigate the growing challenge of ED crowding.
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