Introduction Emergency department (ED) crowding is recognised as a major public health problem. While there is agreement that ED crowding harms patients, there is less agreement about the best way to measure ED crowding. We have previously derived an eight-point measure of ED crowding by a formal consensus process, the International Crowding Measure in Emergency Departments (ICMED). We aimed to test the feasibility of collecting this measure in real time and to partially validate this measure. Methods We conducted a cross-sectional study in four EDs in England. We conducted independent observations of the measure and compared these with senior clinician's perceptions of crowding and safety. Results We obtained 84 measurements spread evenly across the four EDs. The measure was feasible to collect in real time except for the 'Left Before Being Seen' variable. Increasing numbers of violations of the measure were associated with increasing clinician concerns. The area under the receiver operating characteristic curve was 0.80 (95% CI 0.72 to 0.90) for predicting crowding and 0.74 (95% CI 0.60 to 0.89) for predicting danger. The optimal number of violations for predicting crowding was three, with a sensitivity of 91.2 (95% CI 85.1 to 97.2) and a specificity of 100.0 (92.9-100). The measure predicted clinician concerns better than individual variables such as occupancy. Discussion The ICMED can easily be collected in multiple EDs with different information technology systems. The ICMED seems to predict clinician's concerns about crowding and safety well, but future work is required to validate this before it can be advocated for widespread use.

Objectives & Background Emergency department crowding is recognised as a major public health problem. While there is agreement that emergency department crowding harms patients, there is less agreement about the best way to measure emergency department crowding. We have previously derived an eight point measure of emergency department crowding by a formal consensus process, the International Crowding Measure in Emergency Departments (ICMED). We aimed to test the feasibility of collecting this measure in real time, and to partially validate this measure. Methods We conducted a cross-sectional study in four emergency departments in England. We conducted independent observations of the measure and compared this to senior clinician's perceptions of crowding and safety (see tables 1 and 2). Results We obtained 84 measurements, spread evenly across the four emergency departments. The measure was feasible to collect in real time, except for the ‘Left Before Being Seen’ variable. Increasing numbers of violations of the measure were associated with increasing clinician concerns. The Area under the Receiving Operator Curve was 0.80 (95% CI 0.72–0.90) for predicting crowding and 0.74 (95% CI 0.60–0.89) for predicting danger. The optimal number of violations for predicting crowding was three, with a sensitivity of 91.2 (95% CI 85.1–97.2) and a specificity of 100.0 (92.9–100). The measure predicted clinician concerns better than individual variables such as occupancy. Abstract 007 Table 1 Before After Research ‘hotline' 2 (3%) 0 Verbal 10 (15%) 3 (3%) Notes label 21 (32%) 14 (14%) iPad 0 30 (30%) Not notified 32 (49%) 52 (52%) Total 65 99 Conclusion The ICMED is easily to collect in multiple emergency departments with different IT systems. The ICMED seems to predict clinician's concerns about crowding and safety well, but future work is required to validate this before it can be advocated for widespread use.

Objective: To compare the efficacy of local levonorgestrel intrauterine releasing system and transcervical resection of the endometrium (TCER) in the management of perimenopausal dysfunctional uterine bleeding. Patients and Methods: This study was done at Ain Shams and Al-Azhar University Maternity Hospitals during a period started from January 2019 to January 2021. Patients were followed up at the outpatient gynaecology clinics at regular schedules (3, 6 and 12 months) for one year duration. Perimenopausal patients with DUB were assigned randomly to either the levonorgestrel intrauterine system (n = 35) or endometrial resection (n = 45). Blood loss assessment charts were used to measure menstrual blood loss. Results: Total bleeding score/month decreased from a baseline median of 47.26 to 33.5 (P<0.01) for the levonorgestrel intrauterine system and from 47.13 to 33.9 (P<0.01) for transcervical resection of the endometrium. There was no statically difference in bleeding score before and during treatment between the two groups of women. Conclusion: Both treatments levonorgestrel intrauterine system and transcervical resection of the endometrium efficiently reduced menstrual bleeding. levonorgestrel intrauterine system should be considered the first-line treatment for idiopathic menorrhagia because it is easy to insert, has a sustained effect, provides contraception, may reduce the need for surgery, and is cost-effective and well tolerated.