Multi-dimensional Measurements of Crowding for Pediatric Emergency Departments: A Systematic Review

Abstract

The absence of accepted crowding measurement tools that encompass the unique characteristics of pediatric emergency departments (EDs) creates a deficit in advancing efforts to identify and evaluate solutions for this growing problem. In this systematic review, we examined 4 studies that reported on the development and testing of multidimensional pediatric ED crowding measurements. Two investigations involved models (PEDOCS, SOTU-PED) that measured factors indicative or contributory to crowding. A third investigation developed a model mapping the flow of patients through the pediatric ED. The final study modeled the magnitude of physician’s work load, particularly when this load is high when crowding is likely present, based on patient arrivals, presenting complaints and conditions, and tests ordered. These works from 4 studies on measuring crowding in pediatric EDs show promise, but this field is at an early stage. Future work should concentrate on comparing the utility of crowding measurements across multiple pediatric ED settings.

Emergency department crowding: an overview of reviews describing measures causes, and harms

“…of inpatients ready for discharge No. of staffed acute care beds Inpatient processing times Inpatient laboratory/radiology/CT orders Time from request to bed assignment Time from bed ready to ward transfer Agency nursing expenditures Local home care service availability Alternate level of care bed availability Nearby EDs diverting ambulances ED Work Score CBS System complexity Overcrowding Hazard Scale [ 28 ] Waiting room time Waiting room census ED occupancy [ 21 ] PEDOCS SOTU-PED Model mapping the flow of patients through the pediatric ED Model of physician work- load based on patient arrivals, presenting complaints and conditions, and tests ordered [ 14 ] ED occupancy ED LOS ED volume ED boarding time No. of boarders ED waiting room census NEDOCS EDWIN [ 22 ] Timeliness of care Time to assessment Treatment time Boarding time ED LOS Boarding occupancy ED occupancy Waiting room occupancy Hospital occupancy Hospital LOS Staff experience DNW [ 23 ] Door to provider, Door to order time Door to disposition Door to physician LWBS LBVC Waiting time ED LOS Ambulance ramping Delay to FMC [ 8 ] ED LOS LWBS DNW Hours of ambulance diversion Hours of access block Boarding hours Timed patient disposition targets EDWIN score NEDOCS ED census …”

“…Patient flow measures rely predominantly on time, whereas nonflow measures evaluate the number of people and utilization of resources [ 19 ]. Measures can be further subdivided into their aspect of emergency care: input, throughput, and output [ 14 , 19 – 21 ]. A commonly assessed metric, which falls under the nonflow input category, is the number of waiting room patients and waiting room wait times, including time to triage and time to a bed in the emergency department [ 14 , 21 ].…”

“…Measures can be further subdivided into their aspect of emergency care: input, throughput, and output [ 14 , 19 – 21 ]. A commonly assessed metric, which falls under the nonflow input category, is the number of waiting room patients and waiting room wait times, including time to triage and time to a bed in the emergency department [ 14 , 21 ]. These metrics were found to be reliable across multiple studies, and reinforced by physician feedback, as a good evaluation of crowding and boarding in the emergency department [ 20 ].…”

“…Length of stay in the emergency department, a flow metric reflective of throughput care, was also commonly used and highly predictive of the degree of crowding in emergency departments [ 14 , 21 , 23 ]. This was accompanied by various measures of ED occupancy, including at individual time points and over an established period [ 14 ].…”

Use and Misuse of Emergency Room for Children: Features of Walk-In Consultations and Parental Motivations in a Hospital in Southern Italy

“…Notwithstanding its distinctive role, through the years this area has witnessed a high increase of unnecessary visits that should instead be dealt with by other appropriate primary care services, ideally available and easily reachable in our communities. This unsteady balance between unnecessary primary care consultations wrongly addressed in the ED and available resources reveals an overcrowding condition into emergency rooms, which negatively affects both the patients (through a collateral increase in waiting time, lack of confidentiality, and efficiency) and hospital staff (the higher risk of burnout, lower motivation, and professional satisfaction, increase in violence episodes toward health care professionals for long waits) ( 1 , 2 ). This condition is widespread in several countries around the world and it affects both the pediatric and general ED.…”