Measures of Crowding in the Emergency Department: A Systematic Review

被引：164

作者：

Hwang, Ula ^{[1
,2
]}

McCarthy, Melissa L. ^{[3
]}

Aronsky, Dominik ^{[5
]}

Asplin, Brent ^{[6
]}

Crane, Peter W. ^{[7
]}

Craven, Catherine K. ^{[4
]}

Epstein, Stephen K. ^{[8
]}

Fee, Christopher ^{[9
]}

Handel, Daniel A. ^{[10
]}

Pines, Jesse M. ^{[11
,12
]}

Rathlev, Niels K. ^{[13
]}

Schafermeyer, Robert W. ^{[14
]}

Zwemer, Frank L., Jr. ^{[15
]}

Bernstein, Steven L. ^{[16
]}

机构：

[1] Mt Sinai Sch Med, Dept Emergency Med, New York, NY USA

[2] James J Peters Vet Affairs Med Ctr, Geriatr Res Educ & Clin Ctr, Bronx, NY USA

[3] Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD USA

[4] Johns Hopkins Univ, Sch Med, William H Welch Med Lib, Baltimore, MD USA

[5] Vanderbilt Univ, Med Ctr, Dept Biomed Informat & Emergency Med, Nashville, TN USA

[6] Mayo Clin, Dept Emergency Med, Rochester, MN USA

[7] Univ Rochester, Dept Emergency Med, Rochester, NY USA

[8] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Dept Emergency Med, Boston, MA 02215 USA

[9] Univ Calif San Francisco, Dept Emergency Med, San Francisco, CA 94143 USA

[10] Oregon Hlth & Sci Univ, Dept Emergency Med, Portland, OR 97201 USA

[11] George Washington Univ, Med Ctr, Dept Emergency Med, Washington, DC 20037 USA

[12] George Washington Univ, Med Ctr, Dept Hlth Policy, Washington, DC 20037 USA

[13] Baystate Med Ctr, Dept Emergency Med, Springfield, MA USA

[14] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28203 USA

[15] Virginia Commonwealth Univ, Dept Emergency Med, McGuire VA Med Ctr, Richmond, VA USA

[16] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA

来源：

ACADEMIC EMERGENCY MEDICINE | 2011年 / 18卷 / 05期

关键词：

PATIENT FLOW; OVERCROWDING SCALE; SAFETY NET; MODELS; MORTALITY; VARIABLES; CAPACITY; CENSUS; ACCESS; NUMBER;

D O I：

10.1111/j.1553-2712.2011.01054.x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: Despite consensus regarding the conceptual foundation of crowding, and increasing research on factors and outcomes associated with crowding, there is no criterion standard measure of crowding. The objective was to conduct a systematic review of crowding measures and compare them in conceptual foundation and validity. Methods: This was a systematic, comprehensive review of four medical and health care citation databases to identify studies related to crowding in the emergency department (ED). Publications that "describe the theory, development, implementation, evaluation, or any other aspect of a 'crowding measurement/definition' instrument (qualitative or quantitative)" were included. A "measurement/definition" instrument is anything that assigns a value to the phenomenon of crowding in the ED. Data collected from papers meeting inclusion criteria were: study design, objective, crowding measure, and evidence of validity. All measures were categorized into five measure types (clinician opinion, input factors, throughput factors, output factors, and multidimensional scales). All measures were then indexed to six validation criteria (clinician opinion, ambulance diversion, left without being seen (LWBS), times to care, forecasting or predictions of future crowding, and other). Results: There were 2,660 papers identified by databases; 46 of these papers met inclusion criteria, were original research studies, and were abstracted by reviewers. A total of 71 unique crowding measures were identified. The least commonly used type of crowding measure was clinician opinion, and the most commonly used were numerical counts (number or percentage) of patients and process times associated with patient care. Many measures had moderate to good correlation with validation criteria. Conclusions: Time intervals and patient counts are emerging as the most promising tools for measuring flow and nonflow (i.e., crowding), respectively. Standardized definitions of time intervals (flow) and numerical counts (nonflow) will assist with validation of these metrics across multiple sites and clarify which options emerge as the metrics of choice in this "crowded" field of measures. ACADEMIC EMERGENCY MEDICINE 2011; 18:527-538 (C) 2011 by the Society for Academic Emergency Medicine

引用

页码：526 / 537

页数：12

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