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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

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