What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Emergency Department Crowding (n=106). Intervention: Emergency department crowding. Primary outcome: Agreement that ED crowding is a problem.

What question did this study set out to answer?

This research aims to assess perceptions of emergency department crowding among medical directors in Pennsylvania hospitals.

February 1, 2013Western Journal of Emergency Medicine119 citationsOpen Access

Perceptions of Emergency Department Crowding in the Commonwealth of Pennsylvania

JPJesse M. PinesGeorge Washington University JIJoshua A. IssermanChristiana Care Health System JKJohn J. KellyHospital of the University of Pennsylvania

Key Result

In a survey of Pennsylvania emergency department directors, 83% agreed that ED crowding was a problem, and 65% reported that crowding had worsened over the past 2 years.

Key Points

This research aims to assess perceptions of emergency department crowding among medical directors in Pennsylvania hospitals.
Survey conducted among medical directors/chairs in Pennsylvania EDs in spring 2008
Total of 106 responses with a 68% response rate
83% agreed that ED crowding is a problem
98% believe patient satisfaction suffers during crowding
65% reported that crowding worsened over the past 2 years

Study Design

Type

Cross-Sectional (n=106)

Multicenter

Yes

PICO

Population

106 medical directors and chairs from hospital-based emergency departments in Pennsylvania surveyed to assess perceptions of ED crowding.

Exposure / Comparator

Emergency department crowding

Primary Outcome

Agreement that ED crowding is a problem

Limitations

Self-reported survey answers were not independently verified.
Potential nonresponse bias, as responding EDs were more likely to have residency programs.
Data obtained from medical directors who may have personal biases regarding crowding.
The survey instrument was developed locally and not rigorously validated.
The 4-hour definition of boarding may have underestimated the true prevalence of boarding.

Abstract

INTRODUCTION: The state of emergency department (ED) crowding in Pennsylvania has not previously been reported. METHODS: We assessed perceptions of ED crowding by surveying medical directors/chairs from Pennsylvania EDs in the spring of 2008. RESULTS: A total of 106 completed the questionnaire (68% response rate). A total of 83% (86/104) agreed that ED crowding was a problem; 26% (27/105) reported that at least half of admitted patients boarded for more than 4 hours. Ninety-eight percent (102/104) agreed that patient satisfaction suffers during crowding and 79% (84/106) stated that quality suffers. Sixty-five percent (68/105) reported that crowding had worsened during the past 2 years. Several hospital interventions were used to alleviate crowding: expediting discharges, 81% (86/106); prioritizing ED patients for inpatient beds, 79% (84/106); and ambulance diversion, 55% (57/105). Almost all respondents who had improved ED operations reported that it had reduced crowding. CONCLUSION: ED crowding is a common problem in Pennsylvania and is worsening in the majority of hospitals, despite the implementation of a variety of interventions.

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