Emergency department crowdedness level and its determinants at selected public hospitals in Addis Ababa, Ethiopia
Keywords:
Emergency department, Crowdedness level, National emergency department, Overcrowding scale, Ethiopian.Abstract
Background: Emergency department overcrowding is a critical public health concern,
negatively impacting patient care, safety, and hospital efficiency in Ethiopia and many other countries. It contributes to longer lengths of stay, increased mortality rates, staff burnout, and higher healthcare costs. Objective: This study aimed to assess the level of emergency department overcrowding in Tikur Anbesa Specialized Hospital and St. Paul’s Specialized Hospital in Addis Ababa, Ethiopia, using the National Emergency Department Overcrowding Scale (NEDOCS)
Methods: A cross-sectional study was conducted from June 20 to 27, 2023, enrolling all
patients presenting to the emergency departments during this period. Data were collected
using a standardized checklist adapted from previous studies with adjustments. Hourly
observations were recorded for seven days and analyzed using SPSS version 26.
Results: Over seven-day period, emergency department crowding was assessed every hour
during the daytime, resulting in 84 sampling times. The median NEDOCS score, indicating
crowding severity, was 476.5 (IQR: 363-595), with a mean score of 455.7 (SD ±74.2) and a
range of 287 to 581. The primary factors contributing to overcrowding were prolonged patient
lengths of stay and high patient flow. Nearly 60% (393 patients) stayed beyond 24 hours,
with an average length of stay of 4 days (SD ±2.8), reaching up to 16 days in some cases.
The most frequent reason for extended ED stays was bed scarcity (77.9%).
Conclusion: Emergency departments in the selected hospitals are experiencing critically
high patient volumes, leading to dangerously long wait times. This overcrowding requires
immediate, coordinated action to mitigate its impact on patient care delivery.
