Emergency Department Overcrowding and its Associated Factors at HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia.

Abstract

Background: The emergency department plays a vital role in treating acutely sick patients. Emergency overcrowding will result in compromised emergency patient care. Subjective assessment and the National Emergency Department Overcrowding Study score were used with different emergency departments to assess emergency department overcrowding. There is a scarcity of information in resource-limited countries like Ethiopia, specifically in this study area. Objective: To assess emergency department overcrowding and its associated factors at HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia, from November 01-30, 2022. Methodology: A hospital-based cross-sectional study was employed at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital. There were 120 sampling times and 899 patients were included in this study. The collected data was checked for completeness, entered into EpiData 3.1, and exported to SPSS 25. The agreement of objective and subjective assessment for emergency department overcrowding was assessed with the area under the receiver operating characteristic curves (AUC). Bivariable and multivariable logistic regression analysis was used to determine factors associated with emergency department overcrowding. The association was described using an adjusted odds ratio along with a 95% confidence interval, and a p-value <0.05 was considered to be a statistically significant association. Results: The interrater agreement of physicians and case nurses was strongly correlated with a Cohen's kappa (κ) of 0.80. The national emergency department overcrowding score was strongly associated with subjective assessment of residents and case team nurses, AUC=0.81 and AUC=0.79, respectively. Emergency departments are considered to be overcrowded in 65.0% and 65.8% of the time, according to nurses and residents’ perceptions, respectively. 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) were significantly associated with emergency department overcrowding. Conclusion: The national emergency department overcrowding score is a good tool for assessing overcrowding. Emergency departments were overcrowded two-thirds of the time. The hospital administrator should give special attention to availability of inpatient beds specially duty hours, exit block, patient stayed more than 24 hours and triaged more than five minutes