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BMC Emergency Medicine

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Open Access 01-12-2019 | Care | Research article

Do health care professionals’ perceptions help to measure the degree of overcrowding in the emergency department? A pilot study in an Italian University hospital

Authors: Andrea Strada, Francesca Bravi, Giorgia Valpiani, Roberto Bentivegna, Tiziano Carradori

Published in: BMC Emergency Medicine | Issue 1/2019

Abstract

Background

Overcrowding in emergency departments (EDs) is internationally recognized as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of overcrowding, including increased length of stay, mortality and cost per admission. This study measures overcrowding in EDs through health care professionals’ perceptions of it, comparing the results with the NEDOCS score, an objectively validated measurement tool and describing meaningful tools and strategies used to manage ED overcrowding.

Methods

This single-centre prospective, observational, pilot study was conducted from February 19th to March 7th, 2018 at the ED in the University Hospital of Ferrara, Italy to measure the agreement of the NEDOCS, comparing objective scores with healthcare professionals’ perception of overcrowding, using the kappa statistic assessing linear weights according to Cohen’s method. The tools and strategies used to manage ED overcrowding are described.

Results

Seventy-two healthcare professionals (66.1% of 109 eligible subjects) were included in the analyses. The study obtained a total of 262 surveys from 23 ED physicians (31.9%), 31 nurses (43.1%) and 18 nursing assistants (25.0%) and a total of 262 NEDOCS scores. The agreement between the NEDOCS and the subjective scales was poor (k = 0.381, 95% CI 0.313–0.450).

Conclusions

The subjective health care professionals’ perceptions did not provide an adequate real-time measure of the current demands and capacity of the ED. A more objective measure is needed to make quality decisions about health care professional needs and the ability to manage patients to ensure the provision of proper care.

Drummond AJ. No room at the inn: overcrowding in Ontario's emergency departments. CJEM. 2002 Mar; 4 (2):91–97. PubMed PMID: 17612426.CrossRef

Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003 20(5):402–405. Review. doi: https://doi.org/10.1136/emj.20.5.402 PubMed PMID: 12954674.

Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008; 52(2):126–136. doi: https://doi.org/10.1016/j.annemergmed.2008.03.014. Epub 2008 Apr 23. Review. PubMed PMID: 18433933.

Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med 2015;10 (2):171–175. doi: https://doi.org/10.1007/s11739-014-1154-8. Epub 2014 Dec 2. PubMed PMID: 25446540.CrossRef

van der Linden N, van der Linden MC, Richards JR, Derlet RW, Grootendorst DC, van den Brand CL. Effects of emergency department crowding on the delivery of timely care in an inner-city hospital in the Netherlands. Eur J Emerg Med 2016;23(5):337–343. doi: https://doi.org/10.1097/MEJ.0000000000000268. PubMed PMID: 25831039.CrossRef

Patterson BW, Pulia MS, Ravi S, Hoonakker PLT, Schoofs Hundt A, Wiegmann D, Wirkus EJ, Johnson S, Carayon P. Scope and Influence of Electronic Health Record-Integrated Clinical Decision Support in the Emergency Department: A Systematic Review. Ann Emerg Med. 2019. doi:https://doi.org/10.1016/j.annemergmed.2018.10.034. [Epub ahead of print] PubMed PMID: 30611639.CrossRef

Hodgins MJ, Moore N, Legere L. Who is sleeping in our beds? Factors predicting the ED boarding of admitted patients for more than 2 hours. J Emerg Nurs 2011; 37(3):225–230. doi: https://doi.org/10.1016/j.jen.2010.02.020. Epub 2010 Mar 31. PubMed PMID: 21550454.CrossRef

Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, Bernhard M, Bertini A, Gries A, Ferrandiz S, Kumar VA, Harjola VP, Hogan B, Madsen B, Mason S, Ohlén G, Rainer T, Rathlev N, Revue E, Richardson D, Sattarian M, Schull MJ. International perspectives on emergency department crowding. Acad Emerg Med 2011; 18(12):1358–1370. doi: https://doi.org/10.1111/j.1553-2712.2011.01235.x. Review. PubMed PMID: 22168200.CrossRef

Timm NL, Ho ML, Luria JW. Pediatric emergency department overcrowding and impact on patient flow outcomes. Acad Emerg Med 2008; 15(9):832–837. doi: https://doi.org/10.1111/j.1553-2712.2008.00224.x. PubMed PMID: 18821860.CrossRef

10.

Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding, part 1--concept, causes, and moral consequences. Ann Emerg Med 2009; 53 (5):605–611. doi: https://doi.org/10.1016/j.annemergmed.2008.09.019. Epub 2008 Nov 22. Review. PubMed PMID: 19027193.CrossRef

11.

Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. Emergency department crowding, part 2--barriers to reform and strategies to overcome them. Ann Emerg Med 2009; 53 (5):612–617. doi: https://doi.org/10.1016/j.annemergmed.2008.09.024. Epub 2008 Nov 22. Review. PubMed PMID: 19027194.CrossRef

12.

Barishansky RM, O’Connor KE. The effect of emergency department crowding on ambulance availability. Ann Emerg Med 2004; 44:280–281. PubMed PMID: 15332307.CrossRef

13.

Barrett TW, Schriger DL. Annals of emergency medicine journal Club. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med 2008;51(1):6–7. doi: https://doi.org/10.1016/j.annemergmed.2007.11.022. PubMed PMID: 18166434.CrossRef

14.

Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR; Society for Academic Emergency Medicine, emergency department crowding task force. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009; 16 (1):1–10. doi: https://doi.org/10.1111/j.1553-2712.2008.00295.x. Epub 2008 Nov 8. Review. PubMed PMID: 19007346.CrossRef

15.

Weber EJ, Mason S, Freeman JV, Coster J. Implications of England's four-hour target for quality of care and resource use in the emergency department. Ann Emerg Med 2012; 60(6):699–706. doi: https://doi.org/10.1016/j.annemergmed.2012.08.009. Epub 2012 Oct 23. PubMed PMID: 23102917.CrossRef

16.

Vermeulen MJ, Guttmann A, Stukel TA, Kachra A, Sivilotti ML, Rowe BH, Dreyer J, Bell R, Schull M. Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis. BMJ Qual Saf 2016; 25(7):489–498. doi: https://doi.org/10.1136/bmjqs-2015-004189. Epub 2015 Aug 13. PubMed PMID: 26271919; PubMed Central PMCID: PMC4941160.CrossRef

17.

Jones PG, Olsen S. Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the 'Shorter stays in ED' target. Emerg Med Australas 2011;23(5):587–592. doi: https://doi.org/10.1111/j.1742-6723.2011.01451.x. Epub 2011 Jun 27. PubMed PMID: 21995473.CrossRef

18.

Geelhoed GC, de Klerk NH. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust. 2012;196:122–6 Erratum in: Med J Aust. 2012 Mar 5; 196(4):245. PubMed PMID: 22304606.CrossRef

19.

Delibera 1827 del 17/11/2017. Linee di indirizzo alle Aziende Sanitarie per la gestione del sovraffollamento nelle strutture di Pronto Soccorso della Regione Emilia-Romagna https://bur.regione.emilia-romagna.it/dettaglio-inserzione?i=e8add067b5664058bd668d524acdc32c (last accessed 24 Jan 2019).

20.

Stang AS, Crotts J, Johnson DW, Hartling L, Guttmann A. Crowding measures associated with the quality of emergency department care: a systematic review. Acad Emerg Med 2015; 22 (6):643–656. doi: https://doi.org/10.1111/acem.12682. Epub 2015 May 20. Review. PubMed PMID: 25996053.CrossRef

21.

Wang H, Robinson RD, Garrett JS, Bunch K, Huggins CA, Watson K, Daniels J,Banks B, D'Etienne JP, Zenarosa NR. Use of the SONET score to evaluate high volume emergency department overcrowding: a prospective derivation and validation study. Emerg Med Int 2015; 2015: 401757. doi: https://doi.org/10.1155/2015/401757. Epub 2015 Jun 8. PubMed PMID: 26167302; PubMed Central PMCID: PMC4475699.CrossRef

22.

Wang H, Ojha RP, Robinson RD, Jackson BE, Shaikh SA, Cowden CD, Shyamanand R,Leuck J, Schrader CD, Zenarosa NR. Optimal Measurement Interval for Emergency Department Crowding Estimation Tools. Ann Emerg Med. 2017;70 (5):632–639.e4. doi: https://doi.org/10.1016/j.annemergmed.2017.04.012. Epub 2017 Jul 6. PubMed PMID: 28688771.CrossRef

23.

Weiss SJ, Derlet R, Arndahl J, et al. Estimating the degree of emergency department overcrowding in academic medical centers: results of the national ED overcrowding study (NEDOCS). Acad Emerg Med. 2004;11:38–50.CrossRef

24.

Bernstein SL, Verghese V, Leung W, et al. Development and validation of a new index to measure emergency department crowding. Acad Emerg Med. 2003;10:938–42.CrossRef

25.

Boyle A, Abel G, Raut P, Austin R, Dhakshinamoorthy V, Ayyamuthu R, Murdoch I, Burton J. Comparison of the international crowding measure in emergency departments (ICMED) and the National Emergency Department Overcrowding Score (NEDOCS) to measure emergency department crowding: pilot study. Emerg Med J 2016; 33(5):307–312. doi: https://doi.org/10.1136/emermed-2014-203616. Epub 2016 Jan 6. PubMed PMID: 26739294CrossRef

26.

Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227–236. Review. PubMed PMID: 2197679.CrossRef

27.

Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:213–20.CrossRef

28.

Fleiss JL, Cohen J, Everitt BS. Large sample standard errors of kappa and weighted kappa. Psychol Bull. 1969;72:323–7.CrossRef

29.

Cohen J. Weighted kappa: normal scale agreement with provision for scaled disagreement or partial credit. Psych Bulletin. 1968;6:213–20.CrossRef

30.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRef

31.

Garcia-Romero M, Rita-Gáfaro CG, Quintero-Manzano J, Angarita AB. NEDOCS vs subjective evaluation, Is the health personnel of the emergency department aware of its overcrowding Colomb Med (Cali) 2017; 48(2):53–57. PubMed PMID: 28924304; PubMed Central PMCID: PMC5597093.

32.

Reeder TJ, Burleson DL, Garrison HG. The overcrowded emergency department: a comparison of staff perceptions. Acad Emerg Med 2003; 10(10):1059–1064. PubMed PMID: 14525738.CrossRef

33.

The World Health Report. Health systems: improving performance. Geneva: World Health Organization; 2000. https://www.who.int/whr/2000/en/ (last accessed 24 Jan 2019)

34.

Improta G, Romano M, Di Cicco MV, Ferraro A, Borrelli A, Verdoliva C, Triassi M, Cesarelli M. Lean thinking to improve emergency department throughput at AORN Cardarelli hospital. BMC Health Serv Res. 2018;18(1):914. https://doi.org/10.1186/s12913-018-3654-0.CrossRefPubMedPubMedCentral

Title: Do health care professionals’ perceptions help to measure the degree of overcrowding in the emergency department? A pilot study in an Italian University hospital
Authors: Andrea Strada
Francesca Bravi
Giorgia Valpiani
Roberto Bentivegna
Tiziano Carradori
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Emergency Medicine / Issue 1/2019
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-019-0259-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Do health care professionals’ perceptions help to measure the degree of overcrowding in the emergency department? A pilot study in an Italian University hospital

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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