Factors Influencing Crowding and Patients Flow in the Emergency Department: A Case Study of Tema General Hospital

Abstract

There is a general impression that most Emergency Departments are crowded and that affects the quality of care of patients that visit the ED. This research sought to study the factors that influence crowding and patients flow at the ED of Tema General Hospital (TGH). To do this two throughput factors (door-to- doctor time and dwell time) were studied. In order to objectively and statistically access the crowding status of the ED, the Community Emergency Department Overcrowding Study (CEDOCS) was adopted and overall impact of ED crowding on patient outcome was also accessed. A prospective cross-sectional study was conducted capturing adult patients seen or waiting to be seen at the Adult ED of TGH from Monday to Sunday, over a 1 month period (1st December –31st December 2016). A total of 560 patients were enrolled into the study. From the results, hospital related factors were found to significantly (p-value of 0.003 at 95% confidence interval) contribute to crowding at the ED, and ED boarding (53.3%) was the most statistically significant indicator. The ED on the average operated above capacity (average ED occupancy of 140%) for the entire duration of the study. The average door-to-doctor was 31 minutes and that of dwell time was 4.12hours. The average CEDOCS score was found to be 80. From the study 6 days were found to be busy, 21 days extremely busy and 4 days overcrowded. The percentage ratio of patients who died during non-crowded moments was 7% and 14% during crowding moments at the ED. A test of association to establish whether the crowding status influenced mortality at the ED revealed a calculated Chi2 test statistics of 7.3776 with a p-value of 0.007. In conclusion, patients flow at the ED was influenced by hospital related factors and ED crowding impacts negatively on patient outcome.