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

Melaku Getachew; Ibsa Musa; Natanim Degefu; Lemlem Beza; Behailu Hawlte; Fekede Asefa

doi:10.1016/j.afjem.2023.12.002

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

Afr J Emerg Med. 2024 Mar;14(1):26-32. doi: 10.1016/j.afjem.2023.12.002. Epub 2023 Dec 28.

Authors

Melaku Getachew¹, Ibsa Musa², Natanim Degefu³, Lemlem Beza⁴, Behailu Hawlte², Fekede Asefa^{5

6}

Affiliations

¹ Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
² Department of Health Service Management, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
³ Department of Pharmaceutics, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁴ Department of Emergency and Critical Care Nursing, School of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Department of Epidemiology, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁶ Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center - Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, TN, USA.

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.

Keywords: Africa; Emergency departments; Ethiopia; National emergency department overcrowding study score; Overcrowding; crowding.