• Ula Hwang, Ellen J Weber, Lynne D Richardson, Vicki Sweet, Knox Todd, Gallane Abraham, and Felix Ankel.
• Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA. ula.hwang@mountsinai.org
• Acad Emerg Med. 2011 Dec 1;18(12):1318-23.

AbstractThe effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities. To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms. A research agenda is proposed to understand mechanisms that may threaten equity during periods of crowding and design and test potential interventions that may ensure the equitable aspect of quality of care.© 2011 by the Society for Academic Emergency Medicine.

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