The measurement of the emergency department crowding by the scientific methods

Emergency department (ED) crowding refers to a condition when the needs of patients in the ED and patients in the waiting room exceed the capacity of the department. In order to prevent the overcrowding, the hospitals can benefit the input ? throughput - output model to describe problems of the patient flow in their foundation so that they can determine and control the problems which has the largest influence in their work flow. On the other hand, using real time measurement methods of ED crowding can allow us observation and evaluation of ED data and thus understand the progress in the ED. Results of these measurements can be used to develop the short and long term strategies and to apply it. The most cited reason among the factors causing overcrowding is the prolonged presence in the ED of patients already admitted to the hospital, for who no inpatient beds are available.In this thesis, the evaluation of description, reasons and consequences of the ED crowding is intended and the solutions are proposed. Also the application of the national emergency service department overcrowding study (NEDOCS), one of the measurement method of overcrowding, to ascertain the degree of overcrowding in The Gazi University Medical School Hospital Adult ED is included.The results that were displayed by NEDOCS method in The Gazi University Medical School Hospital Adult ED between 31.03.2008 and 07.04.2008 were in the zone of `the dangerously overcrowded?. We determined the reasons of crowding in our ED as high occupancy rate of ED stretchers and the high number of patients who were waiting for available inpatient beds and the existence of the patients in need of the mechanical ventilator and waiting time as long as238 hours for admission into the hospital bed. We also confronted with patients left ED without being evaluated and ambulance diversion in our ED, which are the indicators of inefficient ED care and shown to be associated with the undesired outcomes in the literature.The strategies and plans for prevention of the ED crowding changes according to the region and the hospital. However, the interface of these strategies includes two important actualities. At first, the hospitals must accept ED crowding as not only a problem of the ED itself but also the problem of the hospital. The hospitals evaluating this crisis as a problem of ED will not understand the nature of the problem and their attempt will be failed or partially successful. The other important thing is that the management of the hospitals should give definite and net messages regarding the improvement of patient flow. Otherwise, success chance will decrease dramatically.Unless required regulations and improvements neither are carried out in the near future, it will not be possible to ensure the society to trust timely and high quality health care of ED. This situation will influence the safety net of all people in the country.