Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T23:50:47.283Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding the causes of overcrowding in emergency departments in the Capital Health Region in Alberta: a focus group study

Published online by Cambridge University Press:  21 May 2015

Angela Estey ,
Kathleen Ness ,
L. Duncan Saunders ,
Arif Alibhai  and
Robert A. Bear
Angela Estey*
Affiliation:
Clinical Performance, Information and Research, Capital Health Authority, Edmonton, Alta
Kathleen Ness
Affiliation:
Clinical Performance, Information and Research, Capital Health Authority, Edmonton, Alta
L. Duncan Saunders
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Alta
Arif Alibhai
Affiliation:
Department of Public Health Sciences, University of Alberta, Edmonton, Alta
Robert A. Bear
Affiliation:
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
*
Clinical Performance Information & Research, Capital Health, 9th floor, 9925 109 St., Edmonton AB T5K 2J8; 780 413-7742; AEstey@cha.ab.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To determine the perceptions of health care professionals and service providers with regard to emergency department (ED) overcrowding, including definitions of overcrowding, characteristics of an overcrowded ED, and causes of overcrowding, and secondarily to solicit potential solutions to the problem.

Methods:

Focus groups were conducted with front-line staff, physicians and managers from 7 EDs within an integrated health region. Participants received questions before the sessions, and an experienced moderator conducted the sessions and prepared transcripts from audio tapes. Analyses included identification of key themes and the interrelationships between those themes.

Results:

Focus group participants defined service pressures that result in overcrowding as “anything that impedes the flow of patients through the ED, affects the quality of care delivered or results in patient frustration and stress to staff.” Overcrowding, which can occur at any time of the day, was perceived to have many causes, including some seasonal factors. Two key problems were identified as causing many spin-off pressures: inefficient access to ED beds (stretchers) because of slow throughput of patients and staff shortages. Other perceived causes included the changing role and use of EDs and limited access to services such as home care, diagnostic imaging, laboratory services, social services and specialist care. Participants generally believed that the characteristics and causes of overcrowding could not be viewed independently; rather, in the search for remedies, they should be considered as interrelated variables.

Conclusion:

Qualitative studies of this complex issue can identify and describe complex interactions in real-world settings. The findings of such studies can lead to quantitative studies involving objective measurement.

Keywords

overcrowdingqualitative studiesemergency bed shortagesstaff shortagesemergency department role
Type
ED Administration • L’Administration De La MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 2 , March 2003 , pp. 87 - 94
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Van de Bogart, L.Crisis in the emergency department: contributing factors and potential solutions. In: Hallway medicine. Toronto: Insight Press; 2000.Google Scholar
2.Feferman, I, Cornell, C.How we solved the overcrowding problem in our emergency department. CMAJ 1989;140:273–6.Google ScholarPubMed
3.Derlet, R, Richards, J.Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000; 35(1):83–5.Google Scholar
4.Richards, J, Navarro, M, Derlet, R.Survey of directors of emergency departments in California on overcrowding. West J Med 2000;172(6):385–8.CrossRefGoogle ScholarPubMed
5.Richardson, SK.Increasing patient numbers: the implications for New Zealand emergency departments. Accid Emerg Nurs 1999;7(3):158–63.Google Scholar
6.Coast, J, Ingles, A, Franked, S.Alternatives to hospital care: What are they and who should decide? BMJ 1996;312:162–6.CrossRefGoogle ScholarPubMed
7.Boushy, D, Dubinsky, I.Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient’s perspective. J Emerg Med 1999;17(3):405–12.Google Scholar
8.Lenehan, GP.ED short staffing: It is time to take a hard look at a growing problem and strategies such as standard nurse–patient ratios. J Emerg Nurs 1999;25(2):77–8.CrossRefGoogle Scholar
9.Kyriacou, D, Ricketts, V, Dyne, P, McCollough, M, Talan, D.A 5-year study analysis of emergency department patient care efficiency. Ann Emerg Med 1999;34(3):326–35.Google Scholar
10.Wardrope, J, Kidner, N, Edhouse, J.Bed crises are occurring almost daily in some hospitals. BMJ 1995;310:868–9.CrossRefGoogle ScholarPubMed
11.Fromm, RE Jr, Gibbs, LR, McCallum, WG, Niziol, C, Babcock, JC, Gueler, AC, et al. Critical care in the emergency department: a time based study. Crit Care Med 1993;21(7):970–6.CrossRefGoogle ScholarPubMed
12.Lynn, S, Kellermann, A.Critical decision making: managing the emergency department in an overcrowded hospital. Ann Emerg Med 1991;20:287–92.CrossRefGoogle Scholar
13.Mythbusters series. Myth no. 1: More money would put an end to emergency room crunches. Ottawa: Canadian Health Services Research Foundation; 2000. Available: www.chsrf.ca/docs/resource/myth1_e.pdf (accessed 2003 Feb 6).Google Scholar
14.Conn, AD, Shimkus, GV, Inbornone, R.Eyeing the ED’s open door: how case managers can reduce unnecessary admissions. Dimens Crit Care Nurs 2000;19(2):35–6.CrossRefGoogle ScholarPubMed
15.Derlet, RW, Nishio, D, Cole, LM, Silva, J Jr.Triage of patients out of the emergency department: three-year experience. Am J Emerg Med 1992;10(3):195–9.Google Scholar
16.Hadjistavropoulos, H, Clark, J, Hardenne, D, Lochbaum, B, Larrivee, D.Use of an ER audit to build recommendations for improving quality of care. Part I: Initial audit and recommendations. Healthc Manage Forum 2000;13(2):49–53.CrossRefGoogle ScholarPubMed
17.Hadjistavropoulos, H, Clark, J, Hardenne, D, Lochbaum, B, Larrivee, D.Use of an ER audit to build recommendations for improving quality of care. Part II: Follow-up to an ER study. Healthc Manage Forum 2000;13(2):54–7.CrossRefGoogle Scholar
18.Marshall, C, Rossman, GB.Designing qualitative research. 2nd ed. Thousand Oaks (CA): Sage Publications; 1995.Google Scholar
19.Canadian Association of Emergency Physicians, National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding. CJEM 2001;3(2):82–4.Google Scholar
20.Hider, P, Helliwell, P, Ardagh, M, Kirk, R.The epidemiology of emergency department attendances in Christchurch. N Z Med J 2001;114(1129):157–9.Google ScholarPubMed
21.Menec, VH, Roos, NP, Nowicki, DL, MacWilliam, L, Finlayson, G, Black, C.Seasonal patterns of Winnipeg hospital use. Winnipeg: Manitoba Centre for Health Policy and Evaluation; 1999 Oct.Google Scholar
22.Sinclair, D, Green, R.Emergency department observation unit: Can it be funded through reduced inpatient admission? Ann Emerg Med 1998;32(6):670–5.CrossRefGoogle ScholarPubMed