Abstract Background: Emergency department (ED) overcrowding has become a significant problem throughout the large medical centers, leading to possible threatened medical quality, causing raised stress levels among staff and patients in EDs, and most importantly, adversely affecting patient outcomes. Due to its complexity, a large concerted group effort will be needed to increase awareness, implement proposed solutions, and make a change. ED overcrowding is a multifaceted problem that will require a multifaceted solution. Methods: We set up the "Input-Throughput-Output" model provides a structure for examining the factors that affect ED access, quality and outcomes. Using this model, we clarify the issues of ED overcrowding into three stages, propose ways to obtain needed information in each stage, test the strategies and then evaluate their outcomes. We utilized the analytic hierarchy process (APH) method to measure the weights of the physician¡¦s stress and arrange more efficacious and flexible duties accordingly. Results: This is a prospective study investigating ED overcrowding at this medical center from January 2008 through December 2009. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output. Conclusion: This study suggests that a decrease in ED overcrowding can be achieved through ongoing collaboration of the indicators and the implementation of best practices via the Input-Throughput-Output model.

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The purpose of this qualitative study was to explore and describe the extent to which registered nurses’ practice was affected by emergency department overcrowding. Participants were recruited from a tertiary hospital by using the purpose sampling method. Data collection was done using a semi-structured interview guide. Individual interviews were conducted with eight registered nurses working in the paediatric emergency department. Data analysis was conducted using thematic content analysis and Yin’s (2003:178) five-phase cycle. The study findings revealed that the lack of professional nurse leadership and the difficult existing relationship with the physicians were obstacles that had to be obviated if the paediatric ED were to function optimally and best practice were to be achieved. It was revealed that a problematic issue in the setting was that the most critical decisions on allocating where patients should be treated were made by physicians who have more authority than nurses. It was recommended that the ED need to be clearly defined in the policies as an outpatient, emergency care or as an episodic patient care area as “Admission” can mean admission to the ED or admission as an inpatient/boarded patient. / Health Studies / M.A. (Health Studies)

The purpose of this qualitative study was to explore and describe the extent to which registered nurses’ practice was affected by emergency department overcrowding. Participants were recruited from a tertiary hospital by using the purpose sampling method. Data collection was done using a semi-structured interview guide. Individual interviews were conducted with eight registered nurses working in the paediatric emergency department. Data analysis was conducted using thematic content analysis and Yin’s (2003:178) five-phase cycle. The study findings revealed that the lack of professional nurse leadership and the difficult existing relationship with the physicians were obstacles that had to be obviated if the paediatric ED were to function optimally and best practice were to be achieved. It was revealed that a problematic issue in the setting was that the most critical decisions on allocating where patients should be treated were made by physicians who have more authority than nurses. It was recommended that the ED need to be clearly defined in the policies as an outpatient, emergency care or as an episodic patient care area as “Admission” can mean admission to the ED or admission as an inpatient/boarded patient. / Health Studies / M.A. (Health Studies)