Abstract
BackgroundEmergency Department (ED) crowding occurs when demand for care exceeds the available resources. Crowding has been associated with decreased quality of care and increased mortality, but the prevalence on a national level is unknown in most countries.MethodWe performed a national, cross-sectional study on staffing levels, staff workload, occupancy rate and patients waiting for an in-hospital bed (boarding) at five time points during 24 h in Swedish EDs.ResultsComplete data were collected from 37 (51% of all) EDs in Sweden. High occupancy rate indicated crowding at 12 hospitals (37.5%) at 31 out of 170 (18.2%) time points. Mean workload (measured on a scale from 1, no workload to 6, very high workload) was moderate at 2.65 (±1.25). Boarding was more prevalent in academic EDs than rural EDs (median 3 vs 0). There were an average of 2.6, 4.6 and 3.2 patients per registered nurse, enrolled nurse and physician, respectively.ConclusionED crowding based on occupancy rate was prevalent on a national level in Sweden and comparable with international data. Staff workload, boarding and patient to staff ratios were generally lower than previously described.
Highlights
Emergency Department (ED) crowding occurs when demand for care exceeds the available resources
We aimed to study the current levels of crowding at Swedish EDs by assessing patient attendance, occupancy rate, boarding as well as staff numbers and workload
The number of patients seen in the EDs during the 24 h period was not different compared to the daily census of the previous year
Summary
Crowding has been associated with decreased quality of care and increased mortality, but the prevalence on a national level is unknown in most countries. Crowding has been linked to increased inpatient mortality and decreased quality of care [3,4,5,6]. Sweden lacks unified national information about ED attendances but based on government reports from 2010 and 2015, it is clear that ED attendances and waiting times have increased [14] Similar trends are seen in Denmark which has a comparable health care system [15]. Based on the conceptual inputthroughput-output model [17], there is a clear risk of crowding given the increasing number of ED attendances and decreasing number of hospital beds, limiting capacity to admit patients
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