Measuring and Forecasting Emergency Department Crowding in Real Time
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We developed the Ochsner Emergency Department Overcrowding Scale (OEDOCS) to help us measure and respond to crowding among diverse-sized Emergency Departments (ED) within our network. Not satisfied with our current Emergency Department (ED) crowding score, we first surveyed our ED staff to report perceived crowding and then developed models to predict perceived crowding from our Electronic Health Record (EHR) data. Staff at two ED locations, one large and one small, were asked to report a perceived crowding level between 0-200 every four hours for over 3 months. In addition, we collected Electronic Health Record (EHR) data during the same period. Next, we investigated models for predicting perceived crowding. Linear regression performed the best with an RMSE of 41.77 and 41.98% RMSE improvement over our previous crowding score. We have made OEDOCS publicly available.
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Background Crowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay, mortality and cost per admission. Crowding is typically a manifestation of a hospital at full capacity and its main contributor is the practice of boarding patients in the ED. Therefore, a functioning flow system is advised to ease the burden. Different predictive tools/algorithms assess the degree of crowding. The National Emergency Department Overcrowding Scale (NEDOCS) is used effectively in other countries but has not been validated in Ireland. Aims To assess crowding in a major Irish teaching hospital over a three week period at regular time periods using the NEDOCS. To look at the time from decision to admit to ward bed availability in order to improve flow through the department. Staffs perception of crowding was assessed at a random single time point. Methods Application of the NEDOCS score in the Emergency Department along with the use of internal Patient Administration System (PAS) to track patient movement through the ED. Results During the three week period, the NEDOCS score was frequently at level 6 (dangerously overcrowded) or level 5 (severely overcrowded) (see figure 1). Emergency patient registrations peaked between 1000 hours to 1300 hours whereas the peak admission time to wards was between 1900 hours and 2300 hours. At a random time point, Universal staff perception of crowding in the department was perceived as ‘It’s a nice day’. However the NEDOCS level was 4 (overcrowded) suggesting significant crowding. Figure 1 Figure 2 Average reception activity per 24 hour Conclusion Our Hospital is operating at a consistent level of crowding that can negatively impact on patients. Access to inpatient beds is available late in the day, creating a time lag between decision to admit and transfer to ward. Staff perception did not correlate with NEDOCs score, possibly reflecting a conditioning and acceptance of staff to crowding. Discussion We plan to validate the NEDOCS score in an Irish Emergency Department. Crowding is a significant issue in the Irish Healthcare setting. The ‘40% of inpatient beds by 11 am’ needs to be adopted by our hospital. Our study suggests that our emergency staff accept the dysfunctional as the norm.
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Emergency department (ED) crowding has been described as the most serious problem that endangers the reliability of healthcare system worldwide. The aim of this study was to explore the possible relationship of ED crowding status and length of stay in patient received care. In addition, association between LOS and other variables in relation to crowding status has been explored.This is a retrospective cohort analysis study done by using dataset abstracted from Quadra Med Information System of patients visited emergency department of a tertiary university hospital at Eastern Province of Saudi Arabia during the period of January 1st, 2018 to December 30th, 2018. ED occupancy rates were used to define crowding status (as crowding and overcrowding), while the percentage of patient who spent in ED more than 6 hours was used to define the length of stay in ED.There were 53,309 crowded and 57,290 overcrowded presentations in ED. The median length ± interquartile range of the length of stay for low-crowded and high-crowded conditions were 211 ± 606 and 242 ± 659 minutes, respectively. There was a significant association between ED crowding status and length of stay (p < 0.05).The increased patients' length of stay at ED was associated with crowding status of ED. Therefore, decision-makers at ministry of health should develop and implement measures and interventions to shed light on the causes of crowding, to reduce the crowding at ED, and resolve the problem steamed from such crowding for the purpose of shorten patients' length of stay at ED.
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Emergency department (ED) crowding is a major international concern with a negative impact on both patient care and providers. Currently, there is no consensus regarding measure of crowding. Therefore, emergency physicians have to choose between numerous scoring systems, from simple to more complex. The aim of the present study was to compare the complex National Emergency Department Overcrowding Scale (NEDOCS) with the simple ED Occupancy rate (OR) determination. We further evaluated the correlation between these scores and a qualitative assessment of crowding.This study was conducted in two academic and one regional hospital in Liege Province, in Belgium; each accounting for an ED census of over 40,000 patient visits per year. Crowding measures were sampled four times a day, over a two-week period, in January 2016.ED staff considered overcrowding as a major concern in the three ED. Median OR ranged from 68 to 100, while NEDOCS ranged from 64.5 to 76.3. A significant correlation was found in each ED between the OR and the NEDOCS (Pearson r = 0.973, 0.974 and 0.972), as well as between the OR, the NEDOCS and the subjective evaluation by the ED staff (p = 0.001).Crowding evaluation in ED requires validated scores. Our study in three different hospitals demonstrates that simple OR appeared as accurate as more sophisticated NEDOCS. Furthermore, this measure is perfectly correlated with the feeling of ED staff.
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Inmates at a federal correctional institution were examined for their criterion of what constitutes overcrowding. In general, inmates who were housed under highly crowded conditions exhibited less tolerance of overcrowding than did those who were housed under relatively less crowded conditions. Higher crowding also yielded more negative affective responses to the physical environment. This relationship existed only with respect to a social‐density measure of crowding and not for a spatial‐density measure.
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Abstract Background Emergency department (ED) overcrowding is among the biggest and most important problems experienced by ED staff. The number of ED visits is on the increase and remains an unresolved problem. Emergency department overcrowding has become an important problem for emergency care services worldwide. There is a relationship between overcrowding and patients’ negative experiences of using ED and therefore reporting reduced patients’ satisfaction. This study aimed to identify the causes of ED overcrowding, determine the reasons for people’s use of EDs, and develop solutions for reducing ED overcrowding. Methods This study used quantitative methods using a descriptive approach. The participants were patients who visited the ED. A questionnaire was administered to 296 participants between December 2021 and February 2022. The study included 5 different hospitals in Turkey. The data were analyzed using descriptive statistics. Results This study identified the most common presenting medical problems in the ED and why patients used the ED. Reasons for using the ED included patients perceiving their condition as really urgent (62.8%), the ED being open for 24 hours (36.1%), and receiving faster care in the ED (31.4%). This study also developed recommendations for alleviating ED overcrowding. Conclusion This study identified causes of ED overcrowding and some solutions for alleviating the issue. Emergency department overcrowding should be perceived as an international problem, and initiatives for solutions should be implemented quickly.
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Introduction There is uncertainty about the best way to measure emergency department crowding. We have previously developed a consensus-based measure of crowding, the International Crowding Measure in Emergency Departments (ICMED). We aimed to obtain pilot data to evaluate the ability of a shortened form of the ICMED, the sICMED, to predict senior emergency department clinicians’ concerns about crowding and danger compared with a very well-studied measure of emergency department crowding, the National Emergency Department Overcrowding Score (NEDOCS). Methods We collected real-time observations of the sICMED and NEDOCS and compared these with clinicians’ perceptions of crowding and danger on a visual analogue scale. Data were collected in four emergency departments in the East of England. Associations were explored using simple regression, random intercept models and models accounting for correlation between adjacent time points. Results We conducted 82 h of observation in 10 observation sets. Naive modelling suggested strong associations between sICMED and NEDOCS and clinician perceptions of crowding and danger. Further modelling showed that, due to clustering, the association between sICMED and danger persisted, but the association between these two measures and perception of crowding was no longer statistically significant. Conclusions Both sICMED and NEDOCS can be collected easily in a variety of English hospitals. Further studies are required but initial results suggest both scores may have potential use for assessing crowding variation at long timescales, but are less sensitive to hour-by-hour variation. Correlation in time is an important methodological consideration which, if ignored, may lead to erroneous conclusions. Future studies should account for such correlation in both design and analysis.
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