CJEM Articles: crowding

Displaying 1-3 of 3 results

  • If Machiavelli had been an emergency physician
    September 2009 11 5
    Jeffrey Freeman
  • Key indicators of overcrowding in Canadian emergency departments: a Delphi study
    September 2007 9 5
    Brian H. Rowe, Grant Innes, Kenneth Bond, Maria B. Ospina, Michael Schull, Sandra Blitz

    Objective: To identify the level of consensus among a group of Canadian emergency department (ED) experts on the importance of a set of indicators to document ED overcrowding.

    Methods: A 2-round Delphi survey was conducted from February 2005 to April 2005, with a multidisciplinary group of 38 Canadian experts in various aspects of ED operations who rated the relevance of 36 measures and ranked their relative importance as indicators of ED overcrowding.

    Results: The response rates for the first and second rounds were 84% and 87%, respectively. The most important indicator identified by the experts was the percentage of the ED occupied by inpatients (mean on a 7-point Likert-type scale 6.53, standard deviation [SD] 0.80). The other 9 indicators, in order of the importance attributed, were the total number of ED patients (mean 6.35, SD 0.75), the total time in the ED (mean 6.16, SD 1.04), the percentage of time that the ED was at or above capacity (mean 6.16, SD 1.08), the overall bed occupancy (mean 6.19, SD 0.93), the time from bed request to bed assignment (mean 6.06, SD 1.08), the time from triage to care (mean 5.84, SD 1.08) the physician satisfaction (mean 5.84, SD 1.22), the time from bed availability to ward transfer (mean 5.53, SD 1.72) and the number of staffed acute care beds (mean 5.53, SD 1.57).

    Conclusion: Ten clinically important measures were prioritized by the participants as relevant indicators of ED overcrowding. Indicators derived from consensus techniques have face validity, but their metric properties must be tested to ensure their effectiveness for identifying ED overcrowding in different settings.

  • Urban emergency department overcrowding: defining the problem and eliminating misconceptions
    March 2002 4 2
    Donald A. Redelmeier, Michael J. Schull, Pamela M. Slaughter

    Study objective: To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding.

    Methods: A panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel's discussions, and a formal content analysis of audiotaped recordings was conducted.
    Results: The panel considered community, patient, ED and hospital determinants of overcrowding. Of 46 factors postulated in the literature, 21 were not retained by the experts as potentially important determinants of overcrowding. Factors not retained included access to primary care services and seasonal influenza outbreaks. Key determinants retained included admitted patients awaiting beds and patient characteristics. Ambulance diversion was considered to be an appropriate operational definition and proxy measure of ED overcrowding.
    Conclusion: These results help to clarify the conceptual framework around ED overcrowding, and may provide a guide for future research. The relative importance of the determinants must be assessed by prospective studies.