title: The emergency department occupancy rate: a simple measure of emergency department crowding?
abstract: OBJECTIVE
  We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale.
  
  
  METHODS
  A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method.
  
  
  RESULTS
  We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours.
  
  
  CONCLUSIONS
  The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA. mmcarth@jhmi.edu
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McCarthy
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
authors.forename: Ian D
authors.initials: ID
authors.lastname: Jones
authors.forename: James R
authors.initials: JR
authors.lastname: Miner
authors.forename: Roger A
authors.initials: RA
authors.lastname: Band
authors.forename: Jill M
authors.initials: JM
authors.lastname: Baren
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Desmond
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Baumlin
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.forename: Robert
authors.initials: R
authors.lastname: Shesser
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003441:Crowding; D016002:Discriminant Analysis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data