• Michael J Schull, Pamela M Slaughter, and Donald A Redelmeier.
• Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
• Can J Emerg Med. 2002 Mar 1;4(2):76-83.

Study ObjectiveTo develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding.MethodsA panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel's discussions, and a formal content analysis of audiotaped recordings was conducted.ResultsThe panel considered community, patient, ED and hospital determinants of overcrowding. Of 46 factors postulated in the literature, 21 were not retained by the experts as potentially important determinants of overcrowding. Factors not retained included access to primary care services and seasonal influenza outbreaks. Key determinants retained included admitted patients awaiting beds and patient characteristics. Ambulance diversion was considered to be an appropriate operational definition and proxy measure of ED overcrowding.ConclusionThese results help to clarify the conceptual framework around ED overcrowding, and may provide a guide for future research. The relative importance of the determinants must be assessed by prospective studies.

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