Skip to main content Accesibility Help
×
×
Home

Key indicators of overcrowding in Canadian emergency departments: a Delphi study

  • Maria B. Ospina (a1) (a2), Kenneth Bond (a1) (a2), Michael Schull (a3), Grant Innes (a4), Sandra Blitz (a2) and Brian H. Rowe (a2)...
Abstract
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 multi-disciplinary 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 in-patients (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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Key indicators of overcrowding in Canadian emergency departments: a Delphi study
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Key indicators of overcrowding in Canadian emergency departments: a Delphi study
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Key indicators of overcrowding in Canadian emergency departments: a Delphi study
      Available formats
      ×
Copyright
Corresponding author
Department of Emergency Medicine, University of Alberta, 1G1.43 WMC, 8440-112 St., Edmonton AB T6G 2B7; brian.rowe@ualberta.ca
References
Hide All
1. Canadian Association of Emergency Physicians / National Emergency Nurses Affiliation. Joint position statement: access to acute care in the setting of emergency department overcrowding. Can J Emerg Med 2003;5:81–6.
2. Rowe, BH, Bond, K, Ospina, MB, et al. Frequency, determinants, and impact of emergency department overcrowding in Canada. [Technology Report No. 67.3]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2006.
3. Hwang, U, Concato, J. Care in the emergency department: How crowded is overcrowded? Acad Emerg Med 2004;11:1097–101.
4. Solberg, LI, Asplin, BR, Weinick, RM, et al. Emergency department crowding: consensus development of potential measures. Ann Emerg Med 2003;42:824–34.
5. Schull, MJ, Slaughter, PM, Redelmeier, DA. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. Can J Emerg Med 2002;4:7683.
6. Weiss, SJ, Derlet, R, Arndahl, J, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med 2004;11:3850.
7. Derlet, RW, Weiss, SJ, Ernst, AA, et al. Development of an emergency department overcrowding scale. Results of the national ED overcrowding study (NEDOCS). Acad Emerg Med 2002;9:366.
8. Reeder, TJ, Burleson, DL, Garrison, HG. The overcrowded emergency department: a comparison of staff perceptions. Acad Emerg Med 2003;10:1059–64.
9. Bernstein, SL, Verghese, V, Leung, W, et al. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med 2003;10:938–42.
10. Crisp, J, Pelletier, D, Duffield, C, et al. The Delphi method? Nurs Res 1997;46:116–8.
11. Broomfield, D, Humphries, GM. Using the Delphi technique to identify the cancer education requirements of general practitioners. Med Educ 2001;35:928–37.
12. Beattie, E, Mackway-Jones, K. A Delphi study to identify performance indicators for emergency medicine. Emerg Med J 2004;21:4750.
13. Taylor, WJ. Preliminary identification of core domains for outcome studies in psoriatic arthritis using Delphi methods. Ann Rheum Dis 2005;64(Suppl 2):ii110–22.
14. Graff, L. Overcrowding in the ED: an international symptom of health care system failure. Am J Emerg Med 1999;17:208–99.
15. Asplin, BR, Magid, DJ, Rhodes, KV, et al. A conceptual model of emergency department crowding. Ann Emerg Med 2003;42:173–80.
16. Fatovich, DM. Emergency medicine. BMJ 2002;324:958–62.
17. Australasian College for Emergency Medicine. Access block and overcrowding in emergency departments. 2004. p 122. Available: http://www.acem.org.au/media/Access_Block1.pdf (accessed 2007 Mar 7).
18. Australasian College for Emergency Medicine. The relationship between emergency department overcrowding and alternative after-hours GP services. West Melbourne: The College; 2004. Available: http://www.medeserv.com.au/acem/open/documents/after_hoursgp.pdf (accessed 2007 Mar 7).
19. Fatovich, DM, Nagree, Y, Sprivulis, P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22:351–4.
20. Falvo, T, Grove, L, Stachura, R, et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007;14:332–7.
21. Reeder, TJ, Tucker, JL, Cascio, ES, et al. Trends in emergency department utilization. Effect of changing demographics. Acad Emerg Med 2001;8:577.
22. Richardson, DB. A new definition of emergency department overcrowding using point occupancy. Acad Emerg Med 2004;11:462.
23. Estey, A, Ness, K, Saunders, LD, et al. Understanding the causes of overcrowding in emergency departments in the Capital Health Region in Alberta: a focus group study. Can J Emerg Med 2003;5:8794.
24. Cameron, PA, Campbell, DA. Responses to access block in Australia: Royal Melbourne Hospital. Med J Aust 2003;178:109–10.
25. Richardson, DB. Prospective validation of point occupancy definition of overcrowding. Acad Emerg Med 2004;11:462–3.
26. Locker, TE, Mason, SM. Analysis of the distribution of time that patients spend in emergency departments. BMJ 2005;330:1188–9.
27. Alberti, G. Transforming Emergency Care in England. COI Communications for the Department of Health, United Kingdom; 2004. Available: http://www.dh.gov.uk/assetRoot/04/09/17/81/04091781.pdf (accessed 2007 Mar 7).
28. NHS Modernisation Agency. Emergency services collaborative. improvements in emergency care: case studies. NHS Modernisation Agency; 2002. Available: http://www.modern.nhs.uk/esc/8237/Case%20Studies%20%20Low%20Res%20.pdf (accessed 2007 Mar 7).
29. General Accounting Office. Hospital emergency departments: crowded conditions vary among hospitals and communities. Washington (DC): The Office; 2003.
30. Institute of Medicine of the National Academies. Hospital-based emergency care: at the breaking point. Washington (DC): The Institute; 2006. Available:http://www.iom.edu/CMS/3809/16107/35007.aspx (accessed 2007 Mar 7).
31. Weiss, SJ, Arndahl, J, Ernst, AA, et al. Development of a site sampling form for evaluation of ED overcrowding. Med Sci Monit 2002;8:549–53.
32. Schull, MJ, Lazier, K, Vermeulen, M, et al. Emergency department contributors to ambulance diversion: a quantitative analysis. Ann Emerg Med 2003;41:467–76.
33. Asplin, BR. Measuring overcrowding: time for a paradigm shift. Acad Emerg Med 2006;13:459–61.
34. Hasson, F, Keeney, S, McKenna, H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000;32:1008–15.
35. Rowe, G, Wright, G, Bolger, F. Delphi: a re-evaluation of research and theory. Technol Forecast Soc Change 1991;39:235–51.
36. Harris, DR, Connolly, H, Christenson, J, et al. Pitfalls of email survey research. Can J Emerg Med 2003;5(3). Available: http://caep.ca/template.asp?id=E6946BBBF1804F4AAEF600DAF7F37B63#079 (accessed 2007 Mar 7).
37. Rowe, BH, Bond, K, Ospina, MB, et al. Data collection on patients in emergency departments in Canada. Can J Emerg Med 2006;8:417–26.
38. Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(Suppl 3). Available: http://www.caep.ca.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed