Clinical Performance, Information and Research, Capital Health Authority, Edmonton, Alberta, Canada.
CJEM. 2003 Mar;5(2):87-94. doi: 10.1017/s1481803500008216.
To determine the perceptions of health care professionals and service providers with regard to emergency department (ED) overcrowding, including definitions of overcrowding, characteristics of an overcrowded ED, and causes of overcrowding, and secondarily to solicit potential solutions to the problem.
Focus groups were conducted with front-line staff, physicians and managers from 7 EDs within an integrated health region. Participants received questions before the sessions, and an experienced moderator conducted the sessions and prepared transcripts from audio tapes. Analyses included identification of key themes and the interrelationships between those themes.
Focus group participants defined service pressures that result in overcrowding as "anything that impedes the flow of patients through the ED, affects the quality of care delivered or results in patient frustration and stress to staff." Overcrowding, which can occur at any time of the day, was perceived to have many causes, including some seasonal factors. Two key problems were identified as causing many spin-off pressures: inefficient access to ED beds (stretchers) because of slow throughput of patients and staff shortages. Other perceived causes included the changing role and use of EDs and limited access to services such as home care, diagnostic imaging, laboratory services, social services and specialist care. Participants generally believed that the characteristics and causes of overcrowding could not be viewed independently; rather, in the search for remedies, they should be considered as interrelated variables.
Qualitative studies of this complex issue can identify and describe complex interactions in real-world settings. The findings of such studies can lead to quantitative studies involving objective measurement.
确定卫生保健专业人员和服务提供者对急诊室（ED）过度拥挤的看法，包括过度拥挤的定义、过度拥挤的 ED 的特征以及过度拥挤的原因，并其次寻求解决该问题的潜在方法。
在一个综合卫生区域的 7 个 ED 中，对一线工作人员、医生和管理人员进行了焦点小组讨论。参与者在会议前收到了问题，一位经验丰富的主持人主持了会议，并从录音带中准备了文字记录。分析包括确定关键主题以及这些主题之间的相互关系。
焦点小组参与者将导致过度拥挤的服务压力定义为“任何阻碍患者在 ED 中流动、影响提供的护理质量或导致患者和工作人员感到沮丧和压力的因素”。过度拥挤可能在一天中的任何时间发生，被认为有许多原因，包括一些季节性因素。两个关键问题被确定为导致许多衍生压力的原因：由于患者和工作人员的吞吐量缓慢，导致 ED 床位（担架）的使用效率低下；其他被认为的原因包括 ED 的角色和用途不断变化以及获得家庭护理、诊断成像、实验室服务、社会服务和专科护理等服务的机会有限。参与者普遍认为，过度拥挤的特征和原因不能孤立地看待；相反，在寻找补救措施时，应将它们视为相互关联的变量。
对这一复杂问题的定性研究可以识别和描述现实环境中的复杂相互作用。这些研究的结果可以导致涉及客观测量的定量研究。
