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Urban emergency department overcrowding: defining the problem and eliminating misconceptions
Michael J Schull1, Pamela M Slaughter, Donald A Redelmeier
1Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
CJEM
|July 7, 2007
Summary
Experts defined urban emergency department (ED) overcrowding using ambulance diversion as a key indicator. Admitted patients awaiting beds and patient characteristics were identified as primary determinants, guiding future research on ED overcrowding.
Area of Science:
- Health Services Research
- Emergency Medicine
- Public Health
Background:
- Urban emergency departments (EDs) frequently experience overcrowding.
- Understanding the determinants of ED overcrowding is crucial for improving patient flow and care.
- Existing literature presents numerous potential factors contributing to ED overcrowding.
Purpose of the Study:
- To establish an operational definition for urban emergency department overcrowding.
- To identify a concise list of key determinants contributing to ED overcrowding.
Main Methods:
- A panel of clinical and administrative experts from pre-hospital, ED, and hospital settings was convened.
- Experts reviewed relevant literature prior to facilitated discussions.
- A formal content analysis of audiotaped panel discussions was performed.
Main Results:
- Ambulance diversion was identified as a suitable operational definition and proxy for ED overcrowding.
- Of 46 postulated factors, 21 were excluded by the expert panel.
- Key retained determinants included admitted patients awaiting beds and patient characteristics.
Conclusions:
- The study clarifies the conceptual framework surrounding ED overcrowding.
- The findings provide a foundation for future research into ED overcrowding.
- Prospective studies are needed to assess the relative importance of identified determinants.
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