Development of a site sampling form for evaluation of ED overcrowding

ED overcrowding is fast becoming a national crisis although no definition exists. The purpose of this study is to develop and pilot a sampling form that accurately reflects the concept of ED Overcrowding.

A 26-question site-sampling form was designed based on input from academic physicians at 11 medical schools nationwide. The study was conducted at an inner city Academic medical center. Site-samplings were conducted at 20 times over a one-week period by an independent observer. These times ranged from very slow to severely overcrowded. Information was obtained by counting patients in the waiting room, ED rooms, ED halls and registration/triage, ancillary services, the charge nurse, and the attending physicians. The charge nurse, and ED physicians rated the degree of overcrowding and the ED physician rated the feeling of being rushed. A 'combined outcome variable' was created which consisted of the average responses of nurses and physician's opinion of ED overcrowding and physician's feeling of being rushed. All other data was compared to this outcome variable.

Seven questions were significantly correlated with the combined outcome variable. These were the number of people in the waiting room, patients awaiting triage, patients awaiting registration, full patient rooms, hallway patient, patients awaiting beds, and total registered patients. According to this scale our ED was overcrowded 20% of the time.

This analysis clarifies the definition of overcrowding, helps indicate the variance among responses to overcrowding questions, and provides the foundation for prospective analysis of overcrowding in multiple EDs.