Key result
Census ratio correlated better with staff-perceived workload than occupancy rate (r = 0.75 vs 0.60), providing a more comparable measure of emergency department crowding.
Why the study?
Emergency department occupancy rate is a common measure of crowding, but the comparability of occupancy rates between emergency departments is unknown.
Does census ratio (CR) provide a better measure of emergency department crowding compared to occupancy rate (OR)?
Cross-Sectional (n=37)
Yes
Does census ratio (CR) provide a better measure of emergency department crowding compared to occupancy rate (OR)?
Effect estimate: r = 0.75 vs 0.60
Census ratio (CR) correlates better with staff-perceived workload than occupancy rate (OR) and provides a more comparable measure of emergency department crowding across different facilities.
CR may better reflect ED crowding than OR; hypothesis-generating and requires prospective validation before adoption.
Background Emergency department (ED) crowding causes increased patient morbidity and mortality. ED occupancy rate (OR; patients by treatment beds) is a common measure of crowding, but the comparability of ORs between EDs is unknown. The objective of this investigation was to investigate differences in ORs between EDs using staff-perceived workload as reference. Methods This was a national cross-sectional study in Sweden. EDs provided data on census, treatment beds, staffing, and workload (1–6) at 5 time points. A baseline patient turnover was calculated as the average daily census by treatment beds, denoted turnover per treatment bed (TTB), for each ED. A census ratio (CR), current by daily census, was calculated to adjust for differences in the number of treatment beds. Results Data were returned from 37 (51%) EDs. TTB varied considerably (mean = 4, standard deviation = 1.6; range, 2.1–9.2), and the OR was higher in EDs with TTB >4 compared with ≤4, 0.86 versus 0.43 (0.43; 95% confidence interval [CI], 0.27–0.59), but not workload, 2.75 versus 2.52 (0.23; 95% CI, −0.19 to 0.64). After adjusting for confounders, both TTB (k = −0.3; 95% CI, −0.49 to −0.14) and OR (k = 3.4; 95% CI, 1.76–5.03) affected workload. Correlation with workload was better for CR than for OR (r = 0.75 vs 0.60, respectively). Conclusion OR is affected by patient-to-treatment bed ratios that differ significantly between EDs and should be accounted for when measuring crowding. CR is not affected by baseline treatment beds and is a better comparable measure of crowding compared with OR in this national comparator study.
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Wretborn et al. (2022) conducted a cross-sectional in Emergency department crowding (n=37). Census ratio (CR) vs. Occupancy rate (OR) was evaluated on Correlation with staff-perceived workload (r = 0.75 vs 0.60). Census ratio correlated better with staff-perceived workload than occupancy rate (r = 0.75 vs 0.60), providing a more comparable measure of emergency department crowding.
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