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The emergency department occupancy rate: a simple measure of emergency department crowding?
Ann Emerg Med. 2008 Jan; 51(1):15-24, 24.e1-2.AE

Abstract

STUDY OBJECTIVE

We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale.

METHODS

A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method.

RESULTS

We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours.

CONCLUSION

The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.

Authors+Show Affiliations

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. mmcarth@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Validation Study

Language

eng

PubMed ID

17980458

Citation

McCarthy, Melissa L., et al. "The Emergency Department Occupancy Rate: a Simple Measure of Emergency Department Crowding?" Annals of Emergency Medicine, vol. 51, no. 1, 2008, pp. 15-24, 24.e1-2.
McCarthy ML, Aronsky D, Jones ID, et al. The emergency department occupancy rate: a simple measure of emergency department crowding? Ann Emerg Med. 2008;51(1):15-24, 24.e1-2.
McCarthy, M. L., Aronsky, D., Jones, I. D., Miner, J. R., Band, R. A., Baren, J. M., Desmond, J. S., Baumlin, K. M., Ding, R., & Shesser, R. (2008). The emergency department occupancy rate: a simple measure of emergency department crowding? Annals of Emergency Medicine, 51(1), 15-24, e1-2.
McCarthy ML, et al. The Emergency Department Occupancy Rate: a Simple Measure of Emergency Department Crowding. Ann Emerg Med. 2008;51(1):15-24, 24.e1-2. PubMed PMID: 17980458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The emergency department occupancy rate: a simple measure of emergency department crowding? AU - McCarthy,Melissa L, AU - Aronsky,Dominik, AU - Jones,Ian D, AU - Miner,James R, AU - Band,Roger A, AU - Baren,Jill M, AU - Desmond,Jeffrey S, AU - Baumlin,Kevin M, AU - Ding,Ru, AU - Shesser,Robert, Y1 - 2007/11/05/ PY - 2007/06/09/received PY - 2007/08/22/revised PY - 2007/09/11/accepted PY - 2007/11/6/pubmed PY - 2008/1/18/medline PY - 2007/11/6/entrez SP - 15-24, 24.e1-2 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 51 IS - 1 N2 - STUDY OBJECTIVE: We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. METHODS: A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method. RESULTS: We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours. CONCLUSION: The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/17980458/The_emergency_department_occupancy_rate:_a_simple_measure_of_emergency_department_crowding L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(07)01539-9 DB - PRIME DP - Unbound Medicine ER -