Objectives: No single universal definition of emergency department (ED) overcrowding exists. The authors hypothesize that a previously developed site-sampling form for academic ED overcrowding is a valid model to quantify overcrowding in academic institutions and can be used to develop a validated short form that correlates with overcrowding. Methods: A 23-question site-sampling form was designed based on input from academic physicians at eight medical schools representative of academic EDs nationwide. A total of 336 site-samplings at eight academic medical centers were conducted at 42 computer-generated random times over a three-week period by independent observers at each site. These sampling times ranged from very slow to severely overcrowded. The outcome variable was the degree of overcrowding as assessed by the charge nurse and ED physicians. The full model consisted of objective data that were obtained by counting the number of patients, determining patients' waiting times, and obtaining information from registration, triage, and ancillary services. Specific objective data were indexed to site-specific demographics.

Overcrowding varied widely between academic centers during the study period. Results of a five-question reduced model are valid and accurate in predicting the degree of overcrowding in academic centers.

The rationale behind a regionalized trauma system is that patient outcomes are improved when trauma patients are rapidly transported to facilities with the level of expertise need to treat their injury. Functioning as an adult Level II trauma center, we wanted to know how the transfer process worked for pediatric patients whom we transfer to a Level I pediatric trauma center, which is part of the same multihospital system. Complete information on time of arrival, the time the transfer was accepted, and patient departure time were available for 116 patients (72% of pediatric patients transferred) for the period of January 1, 1997 through June 30, 1998. Patients were retrospectively stratified into two priority groups representing differing transport priority, based on use of a nasogastric tube, endotracheal tube or Foley catheter. Means for decision time and total time in transferring hospital were inspected. Decision time was 44 minutes (standard error 4.5 minutes) for priority patients and 92 minutes (11.5) for non-priority patients (t = 2.94, df = 114, P = 0.004). Total time for priority patients was 129 minutes (7.6) and 197 minutes (14.0) for non-priority patients (t = 3.37, df = 114, P = 0.001). Decision time was not influenced by extensive injury assessment or secondary studies. On average, pediatric patients spent nearly three hours in our facility. Our data indicate that a shorter decision time did not necessarily result in a reduction in wait time. Improving pediatric transfer times requires attention not only to injury assessment processes at the transferring facility and interhospital communications but also mobilization, hand-over, and any space or personnel constraints at the receiving pediatric facility.

No abstract

No abstract