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Crowding of teeth — Clinical Guidelines

Overview

Emergency department (ED) crowding refers to the state where patient volume exceeds the department's capacity to provide timely and efficient care, impacting patient outcomes, resource utilization, and staff performance 5 6.

Diagnosis

Key Indicators: Utilization of tools like NEDOCS (National Emergency Department Overcrowding Study) tool for assessing crowding levels 9.

Measuring Crowding: Comparison of daily vs. hourly measures, static vs. dynamic indicators, and use of regression vs. survival analysis models to quantify crowding effects 15.

Impact Assessment: Evaluating length of stay, treatment delays, and boarding times to understand crowding's impact 15.

Management

Improving Patient Flow: Implementing strategies such as triage optimization, discharge planning, and enhanced communication across departments 6 10.

Resource Allocation: Addressing insufficient resources through better staffing models and resource management 4.

Cultural Shift: Developing hospital-wide understanding and commitment to addressing ED crowding 4.

Policy Advocacy: Leveraging political will and administrative support to enact systemic changes 4.

Special Populations

Education Impact: ED crowding may affect the quality of resident and medical student education, though evidence is mixed; further research needed 20 21.

Key Recommendations

Enhance Communication and Coordination: Develop hospital-wide strategies to improve communication and coordination to mitigate ED crowding (Evidence: Moderate 4).

Implement Evidence-Based Interventions: Adopt validated interventions to improve patient flow, such as triage optimization and discharge planning (Evidence: Strong 6).

Address Resource Limitations: Advocate for and implement strategies to address insufficient resources, including staffing adjustments (Evidence: Moderate 4).

Evaluate and Adapt Measurement Tools: Continuously assess and refine tools for measuring crowding to ensure reliability and validity across different ED settings (Evidence: Weak 9).

Promote Systemic Understanding: Foster a hospital-wide understanding of ED crowding issues to garner broader support and action (Evidence: Expert opinion 4).

References

1 Javidan AP, Hansen K, Higginson I, Jones P, Lang E. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. CJEM 2021. link 2 Javidan AP, Hansen K, Higginson I, Jones P, Lang E. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Emergency medicine Australasia : EMA 2021. link 3 Javidan AP, Hansen K, Higginson I, Jones P, Lang E. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Emergency medicine journal : EMJ 2021. link 4 Rixon A, Wilson S, Judkins S, White P. Directors of emergency medicine's beliefs about, barriers to, and enablers of solutions to emergency department crowding and access block. Emergency medicine Australasia : EMA 2020. link 5 Moskop JC, Geiderman JM, Marshall KD, McGreevy J, Derse AR, Bookman K et al.. Another Look at the Persistent Moral Problem of Emergency Department Crowding. Annals of emergency medicine 2019. link 6 De Freitas L, Goodacre S, O'Hara R, Thokala P, Hariharan S. Interventions to improve patient flow in emergency departments: an umbrella review. Emergency medicine journal : EMJ 2018. link 7 Noel G, Drigues C, Viudes G. Which indicators to include in a crowding scale in an emergency department? A national French Delphi study. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2018. link 8 Wei G, Arya R, Ritz ZT, He AS, Ohman-Strickland PA, McCoy JV. How Does Emergency Department Crowding Affect Medical Student Test Scores and Clerkship Evaluations?. The western journal of emergency medicine 2015. link 9 Wang H, Robinson RD, Bunch K, Huggins CA, Watson K, Jayswal RD et al.. The inaccuracy of determining overcrowding status by using the national ED overcrowding study tool. The American journal of emergency medicine 2014. link 10 McHugh M, Van Dyke KJ, Yonek J, Moss D. Time and expenses associated with the implementation of strategies to reduce emergency department crowding. Journal of emergency nursing 2012. link 11 Wiler JL, Griffey RT, Olsen T. Review of modeling approaches for emergency department patient flow and crowding research. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 12 Ward MJ, Farley H, Khare RK, Kulstad E, Mutter RL, Shesser R et al.. Achieving efficiency in crowded emergency departments: a research agenda. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 13 Hwang U, Weber EJ, Richardson LD, Sweet V, Todd K, Abraham G et al.. A research agenda to assure equity during periods of emergency department crowding. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 14 McClelland MS, Lazar D, Sears V, Wilson M, Siegel B, Pines JM. The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 15 McCarthy ML, Ding R, Pines JM, Zeger SL. Comparison of methods for measuring crowding and its effects on length of stay in the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 16 Pines JM, Pilgrim RL, Schneider SM, Siegel B, Viccellio P. Practical implications of implementing emergency department crowding interventions: summary of a moderated panel. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 17 Kocher KE, Shane SA, Venkatesh AK, Aronsky D, Asplin BR, Rathlev NK. Interventions to safeguard system effectiveness during periods of emergency department crowding. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 18 Pham JC, Trueger NS, Hilton J, Khare RK, Smith JP, Bernstein SL. Interventions to improve patient-centered care during times of emergency department crowding. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 19 Soremekun OA, Terwiesch C, Pines JM. Emergency medicine: an operations management view. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 20 Pines JM, Prabhu A, McCusker CM, Hollander JE. The effect of ED crowding on education. The American journal of emergency medicine 2010. link 21 Shayne P, Lin M, Ufberg JW, Ankel F, Barringer K, Morgan-Edwards S et al.. The effect of emergency department crowding on education: blessing or curse?. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2009. link

Crowding of teeth