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Review
. 2022 Jan 4:14:5-14.
doi: 10.2147/OAEM.S338079. eCollection 2022.

Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List

Samer Badr  1   2 , Andrew Nyce  3   4 , Taha Awan  5 , Dennise Cortes  5 , Cyrus Mowdawalla  5 , Jean-Sebastien Rachoin  1   2   6
Affiliations
Review

Measures of Emergency Department Crowding, a Systematic Review. How to Make Sense of a Long List

Samer Badr et al. Open Access Emerg Med. .

Abstract

Emergency department (ED) crowding, a common and serious phenomenon in many countries, lacks standardized definition and measurement methods. This systematic review critically analyzes the most commonly studied ED crowding measures. We followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We searched PubMed/Medline Database for all studies published in English from January 1st, 1990, until December 1st, 2020. We used the National Institute of Health (NIH) Quality Assessment Tool to grade the included studies. The initial search yielded 2293 titles and abstracts, of whom we thoroughly reviewed 109 studies, then, after adding seven additional, included 90 in the final analysis. We excluded simple surveys, reviews, opinions, case reports, and letters to the editors. We included relevant papers published in English from 1990 to 2020. We did not grade any study as poor and graded 18 as fair and 72 as good. Most studies were conducted in the USA. The most studied crowding measures were the ED occupancy, the ED length of stay, and the ED volume. The most heterogeneous crowding measures were the boarding time and number of boarders. Except for the National ED Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN) scores, the studied measures are easy to calculate and communicate. Quality of care was the most studied outcome. The EDWIN and NEDOCS had no studies with the outcome mortality. The ED length of stay had no studies with the outcome perception of care. ED crowding was often associated with worse outcomes: higher mortality in 45% of the studies, worse quality of care in 75%, and a worse perception of care in 100%. The ED occupancy, ED volume, and ED length of stay are easy to measure, calculate and communicate, are homogenous in their definition, and were the most studied measures.

Keywords: boarding; length of stay; occupancy; overcrowding; volume; waiting room.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
This figure summarizes the method used to select the studies of the review. Out of 2293 abstracts and titles reviewed, 109 were selected for full review. Seven more studies were later induced, and 26 later excluded, yielding a final number of 90 studies.
See this image and copyright information in PMC

References

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    1. The NIH Study Quality Assessment Tools. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed November 18, 2021.
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