Overcrowding in emergency departments (ED) gained significant attention after publication of a seminal Institute of Medicine report in 2006. Since that time, studies illustrating the nature of unintended events, the role of teamwork training, and provider perception of safety risks have further highlighted opportunities for ED error prevention. This study discovered that prolonged ED stays in older patients were associated with increased inpatient adverse events, as well as longer hospital stays. The authors discuss the domino effect of these findings as patients with prolonged inpatient stays reduce bed availability and increase ED stay and overcrowding. A past AHRQ WebM&M commentary discussed a near miss medication error in a busy ED.