title: Emergency department crowding in The Netherlands: managers' experiences.
abstract: BACKGROUND
  In The Netherlands, the state of emergency department (ED) crowding is unknown. Anecdotal evidence suggests that current ED patients experience a longer length of stay (LOS) compared to some years ago, which is indicative of ED crowding. However, no multicenter studies have been performed to quantify LOS and assess crowding at Dutch EDs. We performed this study to describe the current state of emergency departments in The Netherlands regarding patients' length of stay and ED nurse managers' experiences of crowding.
  
  
  METHODS
  A survey was sent to all 94 ED nurse managers in The Netherlands with questions regarding the type of facility, annual ED census, and patients' LOS. Additional questions included whether crowding was ever a problem at the particular ED, how often it occurred, which time periods had the worst episodes of crowding, and what measures the particular ED had undertaken to improve patient flow.
  
  
  RESULTS
  Surveys were collected from 63 EDs (67%). Mean annual ED visits were 24,936 (SD ± 9,840); mean LOS for discharged patients was 119 (SD ± 40) min and mean LOS for admitted patients 146 (SD ± 49) min. Consultation delays, laboratory and radiology delays, and hospital bed shortages for patients needing admission were the most cited reasons for crowding. Admitted patients had a longer LOS because of delays in obtaining inpatient beds. Thirty-nine of 57 respondents (68%) reported that crowding occurred several times a week or even daily, mostly between 12:00 and 20:00. Measures taken by hospitals to manage crowding included placing patients in hallways and using fasttrack with treatment of patients by trained nurse practitioners.
  
  
  CONCLUSIONS
  Despite a relatively short LOS, frequent crowding appears to be a nationwide problem according to Dutch ED nurse managers, with 68% of them reporting that crowding occurred several times a week or even daily. Consultations delays, laboratory and radiology delays, and hospital bed shortage for patients needing admission were believed to be the most important factors contributing to ED crowding.
authors.forename: Christien
authors.initials: C
authors.lastname: van der Linden
authors.forename: Resi
authors.initials: R
authors.lastname: Reijnen
authors.forename: Robert W
authors.initials: RW
authors.lastname: Derlet
authors.forename: Robert
authors.initials: R
authors.lastname: Lindeboom
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.forename: John R
authors.initials: JR
authors.lastname: Richards