title: Key indicators of overcrowding in Canadian emergency departments: a Delphi study.
abstract: OBJECTIVE
  To identify the level of consensus among a group of Canadian emergency department (ED) experts on the importance of a set of indicators to document ED overcrowding.
  
  
  METHODS
  A 2-round Delphi survey was conducted from February 2005 to April 2005, with a multidisciplinary group of 38 Canadian experts in various aspects of ED operations who rated the relevance of 36 measures and ranked their relative importance as indicators of ED overcrowding.
  
  
  RESULTS
  The response rates for the first and second rounds were 84% and 87%, respectively. The most important indicator identified by the experts was the percentage of the ED occupied by inpatients (mean on a 7-point Likert-type scale 6.53, standard deviation [SD] 0.80). The other 9 indicators, in order of the importance attributed, were the total number of ED patients (mean 6.35, SD 0.75), the total time in the ED (mean 6.16, SD 1.04), the percentage of time that the ED was at or above capacity (mean 6.16, SD 1.08), the overall bed occupancy (mean 6.19, SD 0.93), the time from bed request to bed assignment (mean 6.06, SD 1.08), the time from triage to care (mean 5.84, SD 1.08) the physician satisfaction (mean 5.84, SD 1.22), the time from bed availability to ward transfer (mean 5.53, SD 1.72) and the number of staffed acute care beds (mean 5.53, SD 1.57).
  
  
  CONCLUSIONS
  Ten clinically important measures were prioritized by the participants as relevant indicators of ED overcrowding. Indicators derived from consensus techniques have face validity, but their metric properties must be tested to ensure their effectiveness for identifying ED overcrowding in different settings.
authors.affiliation: University of Alberta Evidence-Based Practice Centre, Edmonton, Alberta, Canada.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Ospina
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bond
authors.forename: Michael
authors.initials: M
authors.lastname: Schull
authors.forename: Grant
authors.initials: G
authors.lastname: Innes
authors.forename: Sandra
authors.initials: S
authors.lastname: Blitz
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D003441:Crowding; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006742:Hospital Bed Capacity; D006801:Humans; D010343:Patient Admission; D014218:Triage / Q000458:organization & administration