There were no significant delays in stroke care associated with ED crowding, according to the results of a recent study.1

“As emergency department crowding has become more pervasive, we were curious to explore how crowding has impacted the care of time-critical illnesses,” says Todd Andrew Jaffe, MD, the study’s lead author and a clinical fellow in emergency medicine at Massachusetts General Hospital in Boston.

Jaffe and colleagues decided to examine stroke because diagnosis and treatment is time-dependent. “Our additional question centered around how the processes of care surrounding these time-dependent illnesses, such as stroke, could potentially be protective against ED crowding,” Jaffe says.

They analyzed the level of crowding at the time acute ischemic stroke patients presented to an urban academic ED between 2016 and 2018. Of 1,379 patients, 78% presented at times of normal capacity, 15% presented during times of high crowding, and 7% presented during severe crowding.

Previous research on this subject was mixed. “Some studies found delays in stroke care associated with ED crowding, whereas others did not,” Jaffe observes.

Jaffe and colleagues hypothesized they would see delays in care associated with more crowding. “Yet we were also curious to see how our defined robust processes of care surrounding stroke may be protective,” Jaffe says. The researchers expected some factors (e.g., higher stroke severity) may mitigate delays during heavier crowding. Overall, Jaffe and colleagues found no significant delays associated with ED crowding, which means the systems in place might be protective against crowding.

“As many studies have documented associations for other conditions and ED crowding, it was interesting to not find these delays related to stroke,” Jaffe offers.

These findings provided some assurance EDs can address time-critical illnesses even when crowded, at least when it comes to stroke care. “What is potentially concerning is hypothesizing that other patients may have significant delays in times of crowding,” Jaffe shares.

For example, patients presenting with time-sensitive illnesses, but more vague complaints, may experience significant delays during times of ED crowding as resources are dedicated for more protocolized illnesses. “Although we found no delays in stroke care, many other studies have found delays for other illnesses,” Jaffe says. “Further studies may help identify what patient population poses these risks during times of increased crowding.”


  1. Jaffe TA, Goldstein JN, Yun BJ, et al. Impact of emergency department crowding on delays in acute stroke care. West J Emerg Med 2020;21:892-899.