title: Emergency department crowding affects triage processes.
abstract: BACKGROUND
  During emergency department (ED) crowding there is an imbalance between the need for emergency care and available resources. We assessed the impact of crowding on the triage process.
  
  
  METHODS
  A 1-year health records review of 49,539 patient visits was performed. Data extracted included: occupancy ratio, ED occupancy, demographics, length of stay (LOS), time to triage, triage score, years working as a triage nurse, and triage destination. Data were analyzed using descriptive statistics and regression analyses.
  
  
  RESULTS
  During crowding, target times to triage elapsed more often than during non-crowding (49.7% vs. 24.9%, P <0.001), and more patients were not triaged (2.2% vs. 1.6%, P <0.001). A higher ED occupancy was associated with longer waiting times for triage and longer LOS (P <0.001). There were 12,627 (25.5%) patients redirected to the general practitioner cooperative (GPC). No association between level of crowdedness and number of patients who were redirected to the GPC was found (P = 0.122). Redirection to the GPC occurred significantly more often when the triage nurse had more years working as a triage nurse (P <0.001).
  
  
  CONCLUSIONS
  At this hospital, crowding affects the triage process, leading to longer waiting times to triage and longer ED LOS. Crowding did not influence triage destination.
authors.affiliation: Clinical Epidemiologist, Emergency Department, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, The Netherlands. Electronic address: c.van.der.linden@mchaaglanden.nl.
authors.forename: M Christien
authors.initials: MC
authors.lastname: van der Linden
authors.affiliation: Emergency Nurse Practitioner, Emergency Department, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, The Netherlands.
authors.forename: Barbara E A M
authors.initials: BE
authors.lastname: Meester
authors.affiliation: Research Fellow, Center for Health Economics Research and Evaluation, University of Technology Sydney, P.O. Box 123 Broadway, Sydney, NSW 2007, Australia.
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D014218:Triage / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data
keywords: Emergency department crowding; Emergency service, hospital; Overcrowding; Triage