Document Type : Original Article


1 Department of Pharmacology, PGIMER, Chandigarh, India

2 Department of Anaesthesia, PGIMER, Chandigarh, India,

3 Department of Internal Medicine, PGIMER, Chandigarh, India


BACKGROUND: Emergency department (ED) overcrowding is one of the leading problems of
health‑care organizations, discerned by ED medical staff, but it has never been measured objectively.
OBJECTIVE: A 2 months prospective cross‑sectional study was conducted to compare ED
overcrowding measurement tools with the perceptions of ED emergency physician and ED assistant
nursing superintendent (EDEP/EDANS).
RESULTS: The results have shown that perceptions of ED overcrowding as noted by EDEP and
EDANS, taken on a Likert scale, were 83.34% and 86.67%, respectively. Kappa values show a
significant agreement between EDEP and EDANS subjective perceptions with objective values of the
National Emergency Department Overcrowding Study (NEDOCS), Real‑time Emergency Analysis of
Demand Indicators (READI), and Emergency Department Work Index (EDWIN) scales. Furthermore,
all three scales have statistically significant correlation; NEDOCS and READI had highest level of
correlation coefficient (r = 0.662, P < 0.01) whereas READI and EDWIN shows least correlation
coefficient value (r = 0.155, P < 0.01).
CONCLUSION: Therefore, these scales may serve to quantify the subjective impressions of ED
overcrowding. Evidence is clear of overcrowding harms, measures are needed to provide urgent
medical care and future work up is need of the hour to systematically evaluate interventions and
guide evidence‑based policies.


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