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This aim of this study was to determine the association between emergency department (ED) boarding time, severity of illness, and outcomes for critically ill patients. This was a prospective cohort study of ED patients who met criteria for admission to the intensive care unit (ICU). Patients were divided into 2 groups: those who spent less than 6 hr in the ED prior to transfer, and those who spent 6 hr or more. The groups were compared on the basis of severity of illness, Glasgow Coma Scale score, presence of fever, admission time, and hospital survival. Factors associated with increased mortality included patients who spent 6 hr or longer in the ED, had a fever, were admitted in the evening or night, or were indirect ICU admissions. Length of time spent in the ED prior to transfer to inpatient care is one of several factors associated with increased mortality in critical care patients who were intubated in the ED.