Measures that may indicate overload in the ED:
(1) frequency of overcrowding
(2) problems with initial triage
(3) length of wait for noncritical conditions
(4) patient satisfaction
(5) rate of patient walk-out
(6) need to divert ambulances to other hospitals
(7) use of makeshift patient care areas (cots in hallway, etc.)
(8) ability to respond to critical cases
(9) nurse-to-patient ratio (for critically ill patients this should be around 1:1)
(10) medical error rate
(11) failure to identify a significant change in patient condition
Factors that impact overcrowding:
(1) epidemic or disaster
(2) no free inpatient beds (requiring that patients be held in the ED)
(3) problems with staffing (holiday, illness, worker strike, etc.)
(4) surrounding neighborhood conditions
(5) hospital budget or reimbursement
Limitations:
• Some patients are never satisfied no matter how good the service.
• Comparing performance to other Emergency Departments in the area may not be a reliable metric.
