Authors' objectives:

The main objective of this study was to describe the frequency, determinants, and impact of emergency department (ED) overcrowding in Canada. Secondary objectives were to explore the views and perceptions of ED directors about their facility's state of overcrowding; to determine whether there are differences in frequency, determinants, and impact of overcrowding in EDs in Canada; and to explore the potential association between overcrowding and site characteristics.

Authors' results and conclusions: Of the 243 directors who were sent the survey, 158 completed it (65% response rate). Overcrowding in their facilities was seen as a major or severe problem during the past year, by 62% of responding directors. At least one daily episode of overcrowding occurred in 35% of directors' departments in the last three months, and 35% reported the problem occurred at least once daily during the last three months. Most ED directors (85%) thought that overcrowding could be characterized as "a situation where the demand for emergency services exceeds the ability to provide care in a reasonable amount of time." The median cut-off for a "reasonable" length of time to see a physician was 120 minutes (IQR 60, 120). Of ED directors responding to the survey, 85% attributed overcrowding to lack of admitting beds, a lack of acute care beds (74%), the increased length of stay of admitted patients in the ED (63%), the increased complexity and acuity of patients' symptoms (54%), and the occupancy rate of ED stretchers (52%). Most of the directors (82%) perceived that ED overcrowding increased stress among nurses and made the recruitment and retention of nurses more difficult (68%). Overcrowding was also perceived as having a major or serious impact on ED waiting times (79%), the boarding of admitted patients in the ED while waiting for beds (67%), ED staff satisfaction (66%), and stress among physicians (65%). Furthermore, 51% of directors perceived that ED overcrowding has a major or serious impact on the number of patients who leave without being seen (LWBS). The impact was also perceived in the delays for improving patients' physical, emotional, and mental well-being (54%), and in the risk for poor outcomes (52%).

Authors' recommendations: The results of this study suggest that ED overcrowding is a significant and frequent problem across Canada. It is not limited to large urban centres, nor is it limited to academic and teaching hospitals. Most ED directors perceive access block or an insufficient number of in-patient beds to be the main cause of overcrowding. They perceive that overcrowding lowers the quality and accessibility of emergency care, and increases the stress levels and turnover of ED staff. These perspectives on the problem reinforce the need for more research regarding effective policies and interventions to reduce ED overcrowding.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.cadth.ca/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)