Emergency Department (ED) crowding is recognized as a national crisis. Load-leveling is the process of transferring patients between campuses in the same hospital system for admission to redistribute patient capacity. Our study evaluates the impact of this load-leveling on ED throughput from the transferred patient perspective and on ED operations to evaluate operational benefits and drawbacks.

We performed a retrospective observational study on two EDs in a single health system. These EDs see more than 140,000 visits annually in the same city. Patients were categorized as transferred to the other campus or admitted to the same campus.

Primary outcomes focused on the patients who were load-leveled, examining their boarding times and the effect of load-leveling on their inpatient length-of-stay. Secondary outcomes focused on ED throughput.

A total of 42,046 admissions were included. Of these, 5520 (13.1 %) were load-leveled for admission, while the remaining 36,526 (86.9 %) were kept at the same campus. Load-leveled patients had shorter boarding times by 7.8 h (95 % CI −8.35, −7.31) but no significant difference in inpatient length-of-stay. Load-leveling also reduced door-to-room times and the risk of leaving without being seen, without significant changes in boarding time.

Load-leveling decreases the boarding times and creates capacity for new patients to be seen. As boarding times continue to climb nationally, load-leveling can be a tool for hospital systems to improve patient throughput.