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J Korean Soc Emerg Med > Volume 15(4); 2004 > Article
Journal of The Korean Society of Emergency Medicine 2004;15(4): 261-272.
Definition and Analysis of Overcrowding in the Emergency Department of Ten Tertiary Hospitals
Ki Ok Ahn, Soon Young Yun, Sang Jin Lee, Koo Young Jung, Jun Hwi Cho, Heui Sug Jo
1Department of Emergency Medicine, Seoul Adventist Hospital, Korea.
2Department of Emergency Medicine, College of Medicine, Ewha Woman's University, Korea. kyjung@ewha.ac.kr
3Department of Emergency Medicine, College of Medicine, Kangwon University, Korea.
4Department of Preventive Medicine, College of Medicine, Kangwon University, Korea.
In this research, a definition of overcrowding in emergency department (ED) was proposed, and the actual state of overcrowding in ED was measured by surveys and extensive statistical analysis of data using objective variables.
The emergency physicians (EP) of 10 arbitrarily selected hospitals were questioned about the definition and cause of overcrowding in ED. The hospitals were divided into two groups (high-feeling and low-feeling) in accordance with the survey results. Admission/discharge records of the patients including arrival/departure date and time, were also collected for the duration of 4 weeks with consideration of seasonal variations, from March 2002 to March 2003. Four parameters, the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), which were used for the evaluation of overcrowding, were calculated for each hospital. A statistical analysis was carried out to see whether any difference existed in the BR, the PR, the AR and the DV between weekends and weekdays. Also, a similar statistical method was used to analyze the differences between the high-feeling group and the low feeling group.
In the survey, 83 physicians were asked to answer the questions. The most preferred answers (>70%) for the definition of overcrowding were "saturation of the beds in the ED for more than 6 hours a day."For the cause of overcrowding, the popular answers were "delay in the consultation and the disposition decision" (74.7%), "use of the ED by non-urgent patients"(74.7%), and "lack of inhospital beds"(65.1%). Among the 10 hospitals, 5 hospitals were categorized the high-feeling group, and the rest fell into the low-feeling group. The average BR and AR were higher in high-feeling group than those of low-feeling group (p<0.01, p<0.01). However, average PR of low-feeling group was higher than that of high-feeling group (p<0.01). Average DV did not exhibit any difference between the two groups (p=0.31).
The definition of overcrowding in the ED should include not only the lack of beds in the ED but also patient's acuity and the lack of providers. Certain aspects of overcrowding are clearly different between the high-feeling and the low-feeling groups.
Key words: Crowding, Emergency medicine
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