PMID- 19553772
OWN - NLM
STAT- MEDLINE
DCOM- 20090928
LR  - 20220408
IS  - 1710-2774 (Print)
IS  - 1710-2774 (Linking)
VI  - 12
IP  - 3
DP  - 2009
TI  - Tracking emergency department overcrowding in a tertiary care academic 
      institution.
PG  - 99-106
AB  - Despite the release of a national report describing key markers of emergency 
      department (ED) overcrowding, limited linear data using these markers have been 
      published. We sought to report the degree and trends of ED overcrowding in a 
      typical academic hospital and to highlight some of the key markers of ED patient 
      flow and care. We conducted a prospective study in a large Canadian urban 
      tertiary care teaching hospital that receives approximately 55,000 annual adult 
      ED visits. A database captured demographic and real-time process of care data for 
      each patient from 2000 to 2007. Descriptive data are reported using Canadian 
      Triage and Acuity Scale (CTAS) scores. Over the study period, the ED patient 
      visit volume and presentation times remained predictable. Emergent cases (CTAS 
      levels 1-2) doubled from 8 to 16.6%, and urgent cases (CTAS level 3) increased 
      from 40.2 to 50.3%. Moreover, semi-urgent presentations (CTAS level 4) decreased 
      from 42.4 to 28.8%, and non-urgent cases (CTAS level 5) dropped from 9.4 to 4.3%. 
      The median wait time from triage to bed location increased from two minutes 
      (inter-quartile range [IQR] 1, 46) in 2000 to 27 minutes (IQR 2, 110) in 2007, 
      while the median time from bed location to physician remained constant (29 
      minutes in 2001 versus 28 minutes in 2007). Overall, admissions increased from 
      20.4 to 23%. Semi-urgent and non-urgent admissions dropped from 11.5 to 7.4% and 
      3.2 to 1.8%, respectively. Admitted patients "boarding" in the ED increased from 
      70,955 hours in 2002 to 118,741 hours in 2007, while the number of emergent and 
      urgent patients leaving without being seen increased by more than 400%. ED 
      overcrowding in a tertiary care hospital is primarily a result of access block 
      due to boarding admitted patients, a situation that poses serious risks to the 
      majority of patients who have emergent or urgent conditions that cannot be 
      managed appropriately in the waiting room.
FAU - Bullard, Michael J
AU  - Bullard MJ
AD  - Department of Emergency Medicine at University of Alberta, Edmonton, Alberta. 
      michael.bullard@ualberta.ca
FAU - Villa-Roel, Cristina
AU  - Villa-Roel C
FAU - Bond, Kenneth
AU  - Bond K
FAU - Vester, Michael
AU  - Vester M
FAU - Holroyd, Brian R
AU  - Holroyd BR
FAU - Rowe, Brian H
AU  - Rowe BH
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - Healthc Q
JT  - Healthcare quarterly (Toronto, Ont.)
JID - 101208192
CIN - Healthc Q. 2009;12(3):107-9. PMID: 19553773
MH  - *Academic Medical Centers
MH  - *Crowding
MH  - *Efficiency, Organizational
MH  - Emergency Service, Hospital/*organization & administration
MH  - Female
MH  - Humans
MH  - Male
MH  - Organizational Case Studies
MH  - Prospective Studies
EDAT- 2009/06/26 09:00
MHDA- 2009/09/29 06:00
CRDT- 2009/06/26 09:00
PHST- 2009/06/26 09:00 [entrez]
PHST- 2009/06/26 09:00 [pubmed]
PHST- 2009/09/29 06:00 [medline]
AID - 10.12927/hcq.2013.20884 [doi]
PST - ppublish
SO  - Healthc Q. 2009;12(3):99-106. doi: 10.12927/hcq.2013.20884.