Grant: Operating Grant

Emergency Department (ED) crowding is a system-wide, multi-factorial problem that has become one of the most important issues in health care delivery. ED crowding has been linked to increased mortality and decreased quality of care, especially when associated with high hospital occupancy rates and delays to emergency physician assessment. While most patients, clinicians, administrators and researchers recognize the importance of ED crowding, and can recognize it when they see it, there is no universal standard by which to measure it. Researchers, administrators and policymakers face several challenges in attempting to measure ED crowding. 1)Few crowding metrics have been shown to be associated with important patient outcomes 2)Many crowding metrics exist, and measure similar things 3)Existing comprehensive crowding measures may not be timely or applicable to all hospitals 4)Some crowding metrics are vulnerable to manipulation 5)Little evidence exists to guide the choice between metrics. This project's aim is to identify ED crowding measures that: 1) are highly associated with important patient outcomes; 2) evaluate ED input, throughput, and output issues; 3) are easily measured by most EDs. The identification of the optimal metrics for measurement of ED crowding will be an important development for ED crowding researchers, ED administrators and policymakers, who will then have access to a standardized set of metrics that are valid, important, and generalizable between institutions.