Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia

Abstract

Introduction

Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia.

Methods

A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05.

Results

The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54–3.27), working time (AOR: 2.23; 95 % CI: 1.52–3.26), length of stay (AOR: 2.40; 95 % CI: 1.27–4.54), saturation level (AOR: 2.35; 95 % CI: 1.31–4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37–3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06–2.16).

Conclusion

The study revealed that ED were overcrowded approximately two-thirds of the time.