Emergency department crowding: consensus development of potential measures.

Area of Science:

• Healthcare Operations Research
• Public Health Policy
• Emergency Medicine Management

Background:

• Emergency department (ED) crowding is a significant challenge impacting patient care and hospital efficiency.
• Effective monitoring and management of ED crowding require robust workflow measures.
• Existing measures may not adequately capture the complexities of ED and hospital operations.

Purpose of the Study:

• To identify and refine workflow measures for understanding, monitoring, and managing emergency department (ED) crowding.
• To develop a comprehensive set of measures applicable to both ED and broader hospital operations.
• To assess the operational usefulness and research potential of proposed workflow metrics.

Main Methods:

• A national panel of 74 experts developed 113 potential measures based on a conceptual model of ED crowding (input, throughput, output).
• An iterative process involving 10 investigators and consensus methods refined the measures to a set of 30, rated by all experts using magnitude estimation.
• Further refinement and rating of 8 additional measures resulted in a final set of 38 workflow indicators.

Main Results:

• The initial 113 measures were consolidated into a final set of 38 (15 input, 9 throughput, 14 output).
• Significant variation was observed in the ratings (feasibility, affordability, early warning, planning, operational usefulness, research potential) among the measures.
• The priority ranking of measures addressing similar concepts varied depending on the specific rating category emphasized.

Conclusions:

• The final 38 workflow measures offer a valuable resource for emergency departments and policymakers to address crowding.
• These measures provide a foundation for improving the understanding and management of ED crowding.
• Further rigorous testing is recommended to validate the feasibility, reliability, and practical value of these measures.