title: Emergency Department Crowding Disparity: a Nationwide Cross-Sectional Study.
abstract: In this study, we evaluated national differences in emergency department (ED) crowding to identify factors significantly associated with crowding in institutes and communities across Korea. This was a cross-sectional nationwide observational study using data abstracted from the National Emergency Department Information System (NEDIS). We calculated mean occupancy rates to quantify ED crowding status and divided EDs into three groups according to their occupancy rates (cutoffs: 0.5 and 1.0). Factors potentially related to ED crowding were collected from the NEDIS. We performed a multivariate regression analysis to identify variables significantly associated with ED crowding. A total of 120 EDs were included in the final analysis. Of these, 73 were categorized as 'low crowded' (LC, occupancy rate < 0.50), 37 as 'middle crowded' (MC, 0.50 ≤ occupancy rate < 1.00), 10 EDs as 'high crowded' (HC, 1.00 ≤ occupancy rate). The mean ED occupancy rate varied widely, from 0.06 to 2.33. The median value was 0.39 with interquartile ranges (IQRs) from 0.20 to 0.71. Multivariate analysis revealed that after adjustment, ED crowding was significantly associated with the number of visits, percentage of patients referred, number of nurses, and ED disposition. This nationwide study observed significant variety in ED crowding. Several input, throughput, and output factors were associated with crowding.
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.; Laboratory of Emergency Medical Service, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Won Chul
authors.identifier: 0000-0002-2778-2992
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.; Laboratory of Emergency Medical Service, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ki Ok
authors.identifier: 0000-0002-8446-3269
authors.initials: KO
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.; Laboratory of Emergency Medical Service, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Do
authors.identifier: 0000-0003-4953-2916
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Service, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea .
authors.forename: Jeong Ho
authors.identifier: 0000-0001-6330-9820
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea.; Laboratory of Emergency Medical Service, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Sung
authors.identifier: 0000-0001-6762-4692
authors.initials: JS
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D056910:Republic of Korea; D055815:Young Adult
keywords: Crowding; Emergency Service; Hospital; National Health Program