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Understanding the causes of overcrowding in emergency departments in the Capital Health Region in Alberta: a focus group study

Published online by Cambridge University Press:  21 May 2015

Angela Estey ,
Kathleen Ness ,
L. Duncan Saunders ,
Arif Alibhai  and
Robert A. Bear
Angela Estey*
Affiliation:
Clinical Performance, Information and Research, Capital Health Authority, Edmonton, Alta
Kathleen Ness
Affiliation:
Clinical Performance, Information and Research, Capital Health Authority, Edmonton, Alta
L. Duncan Saunders
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Alta
Arif Alibhai
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Alta
Robert A. Bear
Affiliation:
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
*
Clinical Performance Information & Research, Capital Health, 9th floor, 9925 109 St., Edmonton AB T5K 2J8; 780 413-7742; AEstey@cha.ab.ca

Abstract

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Objectives:

To determine the perceptions of health care professionals and service providers with regard to emergency department (ED) overcrowding, including definitions of overcrowding, characteristics of an overcrowded ED, and causes of overcrowding, and secondarily to solicit potential solutions to the problem.

Methods:

Focus groups were conducted with front-line staff, physicians and managers from 7 EDs within an integrated health region. Participants received questions before the sessions, and an experienced moderator conducted the sessions and prepared transcripts from audio tapes. Analyses included identification of key themes and the interrelationships between those themes.

Results:

Focus group participants defined service pressures that result in overcrowding as “anything that impedes the flow of patients through the ED, affects the quality of care delivered or results in patient frustration and stress to staff.” Overcrowding, which can occur at any time of the day, was perceived to have many causes, including some seasonal factors. Two key problems were identified as causing many spin-off pressures: inefficient access to ED beds (stretchers) because of slow throughput of patients and staff shortages. Other perceived causes included the changing role and use of EDs and limited access to services such as home care, diagnostic imaging, laboratory services, social services and specialist care. Participants generally believed that the characteristics and causes of overcrowding could not be viewed independently; rather, in the search for remedies, they should be considered as interrelated variables.

Conclusion:

Qualitative studies of this complex issue can identify and describe complex interactions in real-world settings. The findings of such studies can lead to quantitative studies involving objective measurement.

Keywords

overcrowdingqualitative studiesemergency bed shortagesstaff shortagesemergency department role
Type
ED Administration • L’Administration De La MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 2 , March 2003 , pp. 87 - 94
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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