• Brett Taylor and Michael Young.
• Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
• CJEM. 2022 Apr 1; 24 (3): 318-324.

ObjectiveEmergency department (ED) crowding is a significant problem in Canada and internationally and is associated with the potential for patient harm. Although pediatric patients represent a significant proportion of overall ED visits, there is limited research on pediatric ED crowding. The Canadian Association of Emergency Physicians defines department crowding as a mismatch between the required and available resources to provide timely emergency care. We propose that rather than crowding, it is better to think of ED patient populations as being more or less "complex" as defined by proxies of the human and physical resources needed for patient management. The study objectives are to explore the utility of a simple and easily available retrospective metric of ED complexity, and to assess the relationship this measure has on patient outcomes in a pediatric ED.MethodsUsing administrative data from a tertiary care pediatric ED, we developed a departmental complexity score based on patient registration number, triage acuity, and departmental length of stay as a proxy for the resources necessary to provide ED care. We then explored the relationship between this departmental complexity score and clinical care indices.ResultsThe score shows a strong relationship with the number of patients who left without being seen by a physician, as well as time to initial MD assessment, both measures which have been used to represent ED crowding in previous research. We found no association between our departmental complexity score and adverse impacts on patient care outcomes of hospital admission, pediatric ICU admission, or patients returning to the ED within 72 h of leaving.ConclusionsThe departmental complexity score has promise as a retrospective measure of departmental resource requirement and may have a role in the ongoing assessment of patient flow.© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

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