Study Presents Clearer Picture of Emergency Department Overcrowding, Sheds New Light on Solutions

May 09, 2006

A major Canadian study, released today, reports that emergency department overcrowding is a frequent and significant occurrence across the country, while shedding new light on potential solutions. “Emergency Department Overcrowding in Canada: What are the Issues and What can be Done?” is the first national, comprehensive study on the issue.

Commissioned by the Canadian Agency for Drugs and Technologies in Health (CADTH), the study includes a review of scientific evidence on emergency department overcrowding and surveys of emergency department directors. It was designed to help Canadian policy makers, hospital and emergency department administrators, and health care researchers better understand the nature of emergency department overcrowding and what they can do about it.

“What this study shows is that emergency department overcrowding is a challenging and system-wide problem with no simple solutions,” said lead author Dr. Brian Rowe, professor and research director of the Department of Emergency Medicine at the University of Alberta. Sixty-two per cent of responding emergency department directors saw overcrowding as a major or severe problem in 2004/2005.

The scientific, evidence-based review and surveys comprise a series of four reports that focus on: measures to document overcrowding; databases and information systems to monitor overcrowding; the frequency, determinants and impacts of overcrowding; and interventions to reduce overcrowding.

The review of scientific evidence reveals:

• fast-track systems can reduce overcrowding, but their resource and space implications must be considered;
• ambulance diversion strategies, short-stay units, staffing changes, and system-wide interventions to reduce overcrowding should be encouraged and monitored, according to limited evidence;
• triaging patients is of unproven benefit in reducing overcrowding; and
• no evidence of effectiveness could be identified for some broadly adopted interventions in Canada.

The results of the national emergency department director survey describe the present state of emergency department overcrowding.

• How it is defined -- 85 per cent of respondents consider overcrowding to be a situation where the demand for emergency services exceeds the ability to provide care in a reasonable amount of time.
• Where it occurs – The survey results show that major or severe overcrowding is much more likely to occur in emergency departments with more than 50,000 visits per year and with 30 or more treatment spaces, in communities with a population of at least 150,000, at university-affiliated hospitals, and at trauma centres.
• What the main causes are – 85 per cent of respondents perceive that the lack of available beds for admitted patients is a major or serious cause of overcrowding.
• The impact – Most ED directors (82%) perceive that overcrowding impacted the stress level among nurses, nursing staff recruitment and retention (68%), ED staff satisfaction (66%), and increased stress among physicians (65%). Seventy-nine per cent feel it has a major or serious impact on emergency department wait times. Fifty-two per cent think overcrowding increases the risk of poor patient outcomes.

Although “Emergency Department Overcrowding in Canada: What are the Issues and What can be Done?” is a comprehensive national assessment, the picture remains somewhat unclear due to inconsistent methods of measuring, collecting, and defining the problem. More work is required. “The findings support the need for a unified, nation-wide emergency department database, which would be invaluable to policy makers,” Dr. Rowe said.

“This thorough review of evidence on overcrowding issues and solutions should assist health care policy makers, administrators and researchers as they revisit and address emergency department overcrowding,” said Mike Gaucher, vice-president of health technology assessment at CADTH.

The Canadian Agency for Drugs and Technologies in Health (CADTH), formerly known as the Canadian Coordinating Office for Health Technology Assessment (CCOHTA), is a significant contributor to Canada’s health care system. Federal, provincial and territorial health care decision makers rely on CADTH to provide them with credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies.

The full reports are available on CADTH’s website

For further information or interview requests, please contact:
Heather Chew, Blueprint Public Relations
Tel: (613) 237-7400 ext. 21
Cell: (613) 797-8626
Email: heather@blueprintpr.ca