A conceptual model of emergency department crowding.

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

[1]  D. Eitel,et al.  Reliability and validity of a new five-level triage instrument. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[2]  T. Bodenheimer,et al.  Improving timely access to primary care: case studies of the advanced access model. , 2003, JAMA.

[3]  D. Houry,et al.  Does sharing process differences reduce patient length of stay in the emergency department? , 2001, Annals of emergency medicine.

[4]  D. Berwick,et al.  Advanced access: reducing waiting and delays in primary care. , 2003, JAMA.

[5]  S. G. Pollock Access of Medicaid recipients to outpatient care. , 1994, The New England journal of medicine.

[6]  A. Kellermann Too sick to wait. , 1991, JAMA.

[7]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[8]  J. Adams,et al.  The endangered safety net: establishing a measure of control. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[9]  J. Geiderman,et al.  D IVERSION OF ALS A MBULANCES : C HARACTERISTICS , C AUSES, AND E FFECTS IN A L ARGE U RBAN S YSTEM , 2001, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[10]  E. Gallagher,et al.  The etiology of medical gridlock: causes of emergency department overcrowding in New York City. , 1990, The Journal of emergency medicine.

[11]  S. Asch,et al.  Trends in the use and capacity of California's emergency departments, 1990-1999. , 2002, Annals of emergency medicine.

[12]  Donald A Redelmeier,et al.  Urban emergency department overcrowding: defining the problem and eliminating misconceptions. , 2002, CJEM.

[13]  K. Rask,et al.  Lack of a regular source of care among children using a public hospital emergency department. , 1999, Pediatric emergency care.

[14]  B. Asplin Tying a knot in the unraveling health care safety net. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[15]  Mark V. Williams,et al.  Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. , 1994, JAMA.

[16]  A. Kellermann,et al.  A shared destiny: community effects of uninsurance. , 2004, Annals of emergency medicine.

[17]  Kevin Grumbach,et al.  Consequences of queuing for care at a public hospital emergency department. , 1991, JAMA.

[18]  Alan J. Forster,et al.  The effect of hospital occupancy on emergency department length of stay and patient disposition. , 2003 .

[19]  A. Kellermann,et al.  Emergency departments and crowding in United States teaching hospitals. , 1991, Annals of emergency medicine.

[20]  D W Baker,et al.  Patients who leave emergency departments without being seen by a physician: magnitude of the problem in Los Angeles County. , 1994, Annals of emergency medicine.

[21]  Oscar Miró,et al.  Effects of external and internal factors on emergency department overcrowding. , 2002, Annals of emergency medicine.

[22]  Robert A Lowe,et al.  Emergency department crowding as a health policy issue: past development, future directions. , 2002, Annals of emergency medicine.

[23]  J. Richards,et al.  Survey of directors of emergency departments in California on overcrowding. , 2000, The Western journal of medicine.

[24]  R. Kravitz,et al.  Frequent overcrowding in U.S. emergency departments. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[25]  R H Brook,et al.  Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. , 1991, JAMA.

[26]  Marian Vermeulen,et al.  Emergency department contributors to ambulance diversion: a quantitative analysis. , 2003, Annals of emergency medicine.