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Urban emergency department overcrowding: defining the problem and eliminating misconceptions

Published online by Cambridge University Press:  21 May 2015

Michael J. Schull ,
Pamela M. Slaughter  and
Donald A. Redelmeier
Michael J. Schull*
Affiliation:
Clinical Epidemiology Unit, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ont Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont
Pamela M. Slaughter
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ont
Donald A. Redelmeier
Affiliation:
Clinical Epidemiology Unit, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ont Institute for Clinical Evaluative Sciences, Toronto, Ont
*
G-147, Clinical Epidemiology Unit, Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Ave., Toronto ON M4N 3M5; 416 480-6100 x3793, fax 416 480-6048, mjs@ices.on.ca

Abstract

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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.

Keywords

emergency departmentcrowdingadministrationambulance diversion
Type
EM Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 2 , March 2002 , pp. 76 - 83
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Derlet, RW, Richards, JR, Kravitz, RL.ED overcrowding: definition and magnitude. Acad Emerg Med 2000;7:544.Google Scholar
2.OHA Region Three Emergency Services Working Group. Final report April 1998. Toronto (ON): Ontario Hospital Association and Ontario Ministry of Health; 1998.Google Scholar
3.Slusarcick, AL, McCaig, LF.National Hospital Ambulatory Medical Care Survey: 1998 outpatient department summary. Adv Data 2000;317:1–23.Google Scholar
4.Brown, EM, Goel, V.Factors related to emergency department use: results from the Ontario Health Survey 1990. Ann Emerg Med 1994;24:1083–91.CrossRefGoogle ScholarPubMed
5.Ontario Hospital Association. A matter of hospital resources: an emergency care action plan. April 2000. Toronto (ON): Ontario Hospital Association; 2000.Google Scholar
6.Lynn, SG, Kellermann, AL.Critical decision making: managing the emergency department in an overcrowded hospital. Ann Emerg Med 1991;20:287–92.Google Scholar
7.American College of Emergency Physicians Task Force. Hospital and emergency department overcrowding. Ann Emerg Med 1990;19:336.CrossRefGoogle Scholar
8.Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding [policy]. CJEM 2001;3(2):82–4.CrossRefGoogle Scholar
9.Schull, MJ, Szalai, J, Schwartz, B, Redelmeier, DA.Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.Google Scholar
10.Kollek, D.Overwhelmed in emergency: examining ER status at Hamilton Civic Hospital. Ont Med Rev 1990;57:11–3.Google Scholar
11.Krochmal, P, Riley, TA.Increased health care costs associated with ED overcrowding. Am J Emerg Med 1994;12:265–6.CrossRefGoogle ScholarPubMed
12.Boyle, T, Daly, R.ER in crisis: shortage of doctors acute, chief says. The Toronto Star 1999 Jan 27;Sect A:1–23.Google Scholar
13.Daly, R.Emergency crisis won’t get well soon. The Toronto Star 1999 Jan 27;Sect C:1–5.Google Scholar
14.Wilkes, J.Paramedics’ burden grows with closings. The Toronto Star 1999 Jan 27;Sect B:5.Google Scholar
15.Goergin, L.13 hospitals forced to turn away patients. Chicago Tribune 1990 Jan 4;1.Google Scholar
16.Evans, H.No room. N Y Daily News 1990 Feb 19.Google Scholar
17.Krieger, LM.Crowded trauma center refused victim. San Francisco Examiner 1990 Sep 27; Sect A:18.Google Scholar
18.Tye, L.Officials offer little hope for emergency room diversions. The Boston Globe 2000 Nov 14;A:12.Google Scholar
19.Report of the Regional Coroner from the inquest into the death of Kyle Martin. Inquest report no. 9801205. Toronto (ON): Ontario Ministry of Health : 1998.Google Scholar
20.Le Coroner en chef, Gouvernement du Québec. Rapport d’enquête : Déces de Jeannine Lacombe (Dossier 95356) 1998;9:21.Google Scholar
21.Gray, C.Hospital crisis? What crisis? CMAJ 2000;162:1043.Google Scholar
22.Derlet, RW, Richards, JR.Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000;3:63–8.CrossRefGoogle Scholar
23.Richards, JR, Navarro, ML, Derlet, RW.Survey of directors of emergency departments in California on overcrowding. West J Med 2000;172:385–8.CrossRefGoogle ScholarPubMed
24.Kellermann, AL.Déjà vu [letter; comment]. Ann Emerg Med 2000;35:83–5.Google Scholar
25.Andrulis, DP, Kellermann, A, Hintz, EA, Hackman, BB, Weslowski, VB.Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 1991;20:980–6.CrossRefGoogle ScholarPubMed
26.Hospital emergency department review: report of the task force on emergency health services. Toronto (ON): Hospital Council of Metropolitan Toronto; 1991.Google Scholar
27.Gallagher, EJ, Lynn, SG.The etiology of medical gridlock: causes of emergency department overcrowding in New York City. J Emerg Med 1990;8:785–90.Google Scholar
28.Glushak, C, Delbridge, TR, Garrison, HG.Ambulance diversion. Standards and Clinical Practices Committee, National Association of EMS Physicians. Prehosp Emerg Care 1997;1:100–3.Google Scholar
29.Coude-Lord, M.Sacré-coeur: les infirmières de soir refusent de travailler dans une urgence engorgée et dangereuse. Le Journal de Montréal 1999 Feb 9;3.Google Scholar
30.Derlet, RW, Richards, JR, Navarro, M.Overcrowding in emergency departments: California versus other states. Ann Emerg Med 1999;34(2 Pt 2):S23.CrossRefGoogle Scholar
31.Derlet, RW, Richards, JR.Overcrowding in academic emergency departments. Acad Emerg Med 1999;6:404–5.Google Scholar
32.Derlet, RW, Richards, JR, Kravitz, RL.Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151–5.Google Scholar
33.Begin, J.Les urgences : plus ca change. La Presse 1999 Jan 30; SectB:3.Google Scholar
34.Small, P.Official recounts ER crisis response. The Toronto Star 2000 Oct 16; Sect: B7.Google Scholar
35.Tesher, E.Time to change course on hospitals. The Toronto Star 2000 Oct 10; Sect: A25.Google Scholar
36.Thorpe, KE.The current hospital crisis in New York City and policy options for resolving it. N Y State J Med 1990; 90:247–52.Google Scholar
37.Blackwell, T.Witmer says ER crisis is a mystery: Hospitals cite shortages. National Post 2000 Sep 28; Sect: A19.Google Scholar
38.Quinn, J, Gillespie, K, Boyle, T.Inside city’s ERs: condition critical. The Toronto Star 1999 Dec 15.Google Scholar
39.Zeller, RA.Focus group research on sensitive topics: setting the agenda without setting the agenda. Successful focus groups: advancing the state of the art. Newbury Park (CA): Sage Publications; 1993. p. 167–83.CrossRefGoogle Scholar
40.Patton, MQ.Variety in qualitative inquiry: theoretical orientations. Qualitative evaluation and research methods. Newbury Park (CA): Sage Publications; 1990. p. 69–86.Google Scholar
41.Redelmeier, DA, Blair, PJ, Collins, WE.No place to unload: a preliminary analysis of the prevalence, risk factors, and consequences of ambulance diversion. Ann Emerg Med 1994;23:43–7.Google Scholar
42.Boyle, P, Pineault, R, Roberge, D.Assessing Quebec’s multicomponent program to reduce emergency room overcrowding. Can Public Policy 1992;18(2):189–202.Google Scholar
43.Pineault, R, Roberge, D, Lambert, J, Boyle, P.Les déterminants organisationnels de la durée du séjour des patients sur civière dans les services d’urgence de dix hopitaux au Québec. Groupe de recherche interdisciplinaire en santé, éditeur. Université de Montréal, Faculté de médecine. 1992;R92–09:1–132.Google Scholar
44.Feferman, I, Cornell, C.How we solved the overcrowding problem in our emergency department. CMAJ 1989;140:273–6.Google ScholarPubMed
45.Patton, MQ.Qualitative analysis and interpretation. Qualitative evaluation and research methods. Newbury Park (CA): Sage Publications; 1990. p. 371–459.Google Scholar
46.Pope, C.Qualitative research in health care: analysing qualitative data. BMJ 2000;320:114–6.CrossRefGoogle Scholar
47.Grumbach, K, Keane, D, Bindman, A.Primary care and public emergency department overcrowding. Am J Public Health 1993; 83:372–8.CrossRefGoogle ScholarPubMed
48.Menec, VH, Roos, NM, Nowicki, DL, MacWilliam, L, Finlayson, G, Black, C, et al. Seasonal patterns of Winnipeg hospital use. Winnipeg (MB): Manitoba Centre for Health Policy and Evaluation, University of Manitoba; 1999.Google Scholar
49.Schull, MJ, Mamdani, M.Influenza virus as a determinant of emergency department overcrowding [abstract]. CJEM 2001;3(2):126–7.Google Scholar
50.Chan, B, Schull, MJ, Schultz, S.Atlas of emergency department services in Ontario 1992/1993 to 1999/2000. ICES Atlas Report Series. Toronto (ON): Institute for Clinical Evaluative Sciences; 2001 Nov.Google Scholar
51.Schappert, SM.National hospital ambulatory medical care survey: 1992 emergency department summary. Vital Health Stat 1997;13:1–15.Google Scholar
52.Derlet, RW, Ledesma, A.Why do patients come to emergency departments? Ann Emerg Med 1999;34(4 Pt 2):S70.CrossRefGoogle Scholar
53.Shih, FY, Ma, MH, Chen, SC, Wang, HP, Fang, CC, Shyu, RS, et al. ED overcrowding in Taiwan: facts and strategies. Am J Emerg Med 1999;17:198–202.Google Scholar
54.Dickinson, G.Emergency department overcrowding [editorial]. CMAJ 1989;140:270–1.Google Scholar
55.Silka, PA, Geiderman, JM, Kim, JY.Diversion of ALS ambulances: characteristics, causes, and effects in a large urban system. Prehosp Emerg Care 2001;5:23–8.CrossRefGoogle Scholar
56.Miro, O, Antonio, MT, Jimenez, S, De Dios, A, Sanchez, M, Borras, A, et al. Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 1999;6:105–7.Google Scholar
57.Egan, N.Managing a bed crisis. J Accid Emerg Med 1999;16:145–6.Google Scholar
58.Fields, W.ED diversions are a troubling trend. Am Coll Emerg Physicians News 2000;Apr:3.Google Scholar