Emergency department overcrowding: Time for a quantitive measure

Abstract

Emergency department overcrowding: Time for a quantitive measuree mm_1189 240Dear Editor, In their article on the association between access block and analgesia for renal colic, Chu and Brown correctly suggest that access block is too crude a measure of ED overcrowding. 1 The definition of ED (over)crowding by the American College of Emergency Physicians encapsulates this problem very well by focusing on the effects -'Crowding occurs when the identified need for emergency services exceeds available resources for patient care in the emergency department (ED), hospital, or both'. 2 Overcrowding can occur from an increase in input factors to the system, such as increased presentations to the ED, reduced throughput, such as reduced staff numbers, and inadequate ancillary services, such as radiology, and reduced output, such as access block. 3 A result of this is that one cannot presume that there is a linear relationship between the extent of access block and ED overcrowding, and thus the quality of patient care. It is, however, difficult to quantify ED overcrowding, purely because it is such a multifactorial problem.I believe that further research in this area must demonstrate a quantitative, reproducible method of determining the problem of overcrowding, to allow us to reliably demonstrate its effect on the quality of the care received by our patients. References1. Chu K, Brown A. Association between access block and time to parenteral opioid analgesia in renal colic: a pilot study. Emerg. Med. Australas. 2009; 21: 38-42. 2. American College of Emergency Physicians. Crowding. Ann. Emerg. Med. 2006; 47: 585. 3. Rathlev NK, Chessare J, Olshaker J et al. Time series analysis of variables associated with daily mean emergency department length of stay. Ann. Emerg. Med. 2007; 49: 265-71.