LETTER TO THE EDITOR

Emergency departmentovercrowding: Time for aquantitive measureemm_1189 240

Dear Editor,In their article on the association between access blockand analgesia for renal colic, Chu and Brown correctlysuggest that access block is too crude a measure of EDovercrowding.1

The definition of ED (over)crowding by the AmericanCollege of Emergency Physicians encapsulates thisproblem very well by focusing on the effects – ‘Crowd-ing occurs when the identified need for emergency ser-vices exceeds available resources for patient care in theemergency department (ED), hospital, or both’.2

Overcrowding can occur from an increase in inputfactors to the system, such as increased presentationsto the ED, reduced throughput, such as reduced staffnumbers, and inadequate ancillary services, such asradiology, and reduced output, such as access block.3

A result of this is that one cannot presume that thereis a linear relationship between the extent of accessblock and ED overcrowding, and thus the quality ofpatient care. It is, however, difficult to quantify ED

overcrowding, purely because it is such a multifactorialproblem.

I believe that further research in this area must dem-onstrate a quantitative, reproducible method of deter-mining the problem of overcrowding, to allow us toreliably demonstrate its effect on the quality of the carereceived by our patients.

References

1. Chu K, Brown A. Association between access block and time toparenteral opioid analgesia in renal colic: a pilot study. Emerg.Med. Australas. 2009; 21: 38–42.

2. American College of Emergency Physicians. Crowding. Ann.Emerg. Med. 2006; 47: 585.

3. Rathlev NK, Chessare J, Olshaker J et al. Time series analysis ofvariables associated with daily mean emergency departmentlength of stay. Ann. Emerg. Med. 2007; 49: 265–71.

Alan E O’Connor

Department of Emergency Medicine, Royal Brisbane and

Women’s Hospital, Brisbane, Queensland, Australia

doi: 10.1111/j.1742-6723.2009.01189.xEmergency Medicine Australasia (2009) 21, 240

© 2009 The AuthorJournal compilation © 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine