International Journal on Science and Technology

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Emergency Department Overcrowding and Nursing-Sensitive Patient Safety Outcomes in a Tertiary Hospital: A Retrospective Observational Study

Author(s) Sarah M. Almutiri, Waad M. Alanazi, Elham S. Alanazi, Ahmed H. Alshammari
Country Saudi Arabia
Abstract Background: Emergency department overcrowding is a common problem in tertiary hospitals and may affect patient safety. Nurses are central to emergency care through triage, monitoring, medication administration, reassessment, and early recognition of deterioration.
Objective: To examine the association between emergency department overcrowding and nursing-sensitive patient safety outcomes in a tertiary hospital.
Methods: A retrospective quantitative observational study was conducted using electronic health records and emergency department administrative data from 1 January to 31 March 2024. The study included 15,284 adult emergency department visits. Emergency department overcrowding was defined as an occupancy rate of 100% or more at the time of patient arrival. The primary outcome was a composite nursing-sensitive patient safety outcome, including delayed medication administration, delayed analgesia, delayed nursing reassessment, medication error, fall, pressure injury, clinical deterioration, left without being seen, left against medical advice, and emergency department mortality. Multivariable logistic regression was used to estimate adjusted odds ratios.
Results: Of the included visits, 6,472 visits (42.3%) occurred during crowded conditions. The composite nursing-sensitive patient safety outcome occurred more frequently during crowded conditions than non-crowded conditions (12.4% vs. 6.4%). After adjustment for age, sex, triage acuity, mode of arrival, shift, day of week, diagnostic category, and admission status, emergency department overcrowding remained significantly associated with the composite safety outcome (adjusted OR = 1.72, 95% CI: 1.52–1.95, p < 0.001). Crowding was also associated with delayed medication administration, delayed analgesia, delayed nursing reassessment, medication error, clinical deterioration, and patients leaving without being seen.
Conclusion: Emergency department overcrowding was common and was associated with higher odds of nursing-sensitive patient safety outcomes. These findings suggest that overcrowding should be treated as a patient safety concern, not only an operational issue. Hospital-wide strategies are needed to reduce crowding, improve patient flow, and support emergency nurses during high-demand periods.
Keywords Emergency department; overcrowding; nursing-sensitive outcomes; patient safety; medication errors; delayed care; ED boarding; tertiary hospital; retrospective study.
Published In Volume 15, Issue 2, April-June 2024
Published On 2024-05-09
DOI https://doi.org/10.5281/zenodo.19886060
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