Published: 2019-03-26

Overcrowding and possible solutions for a busy gynecological emergency department: a hospital-based setting

Mahvish Qazi, Najmus Saqib, Sachin Gupta


Background: The objective of this study is to determine the trends of patients presenting in Obstetrics and Gynecology emergency department and to identify possible solutions.

Methods: This retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the department of Gynecology and Obstetrics and comprised data of all patients presenting to the emergency department between 1st January 2018 to 31st December 2018.  Patients were assessed in terms of demographic features, presenting complaints, admission types (urgent, non-urgent), referral from other hospitals or coming from home. The total number of patients admitted and the number of patients sent home was also recorded.

Results: A total of 1,46,366 patients were analyzed retrospectively. Out of which 63,004 (43.05%) were send home from the OPD while 83,362 (56.95%) presented to the emergency department. Of them, 49,383 (59.24%) were discharged straight away from the ED after emergency treatment and care while 339,79 (40.76%) were admitted. Out of 339,79 patients, 24,932 (73.37%) stayed in the emergency whereas 9047 (26.63%) admitted into different wards for elective procedures. Majority of the patients 26,098 (89.92%) came from home and 2927 patients (10.08%) were referred from other hospitals. Labour pains 7833 (31.42%) was the most common presentation. Trauma was the reason for admission in 112 (0.45%) patients out of 29025. 971 (3.89%) patients presented with gynecological problems. 4093 (14.10%) patients presented with non-urgent indications. Rest of all patients presented with indications which were categorized as urgent and were admitted. All data was analysed using SPSS version 20.

Conclusions: To reduce the overcrowding in the emergency department and improve quality of obstetrics and gynecological services, Inpatients and Outpatient departments at primary and secondary care levels need to be strengthened. Patients with non-urgent problems should be provided adequate care at primary and secondary health care centers.


Emergency department, Labour pains, Overcrowding, Quality of care

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Dickinson G. Emergency department overcrowding. CMAJ: Canadian Med Assoc J. 1989;140(3):270.

Gallagher EJ, Lynn SG. The etiology of medical gridlock causes of emergency department overcrowding in New York City. J Emerg Med. 1990;8(6):785-90.

Derlet RW, Richards JR, Kravitz RL. Frequent overcrowding in US emergency departments. Acad Emerg Med. 2001;8(2):151-5.

Stead LG, Jain A, Decker W, Emergency department over-crowding: a global perspective. Int J Emerg Med. 2009;2(3):133-4.

Thijssen P. H. J., Giesen P. Wensing M, “Emergency departments in the Netherlands,” Emerg Med J.2012;29(1):6-9.

W. C. Cha, S.D. Shin, K. J. Song, S. K. Jung, andG. J. Suh, “Effect of an independent capacity protocol on overcrowding in an urban emergency department,” Academic Emergency Medicine, vol. 16, no. 12, pp. 1277–1283, 2009.

Yamane K. Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities. Washington, DC: US General Accounting Office; 2003. GAO-03-460.

Committee on the Future of Emergency Care in the United States Health System. Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press; 2006.

Gibbs N. " Do you want to die?" The crisis in emergency care is taking its toll on doctors, nurses--and patients. Time. 1990;135(22):58-60.

10. Barrero J. Hospitals get orders to reduce crowding in emergency rooms. New York Times., 1989:1-2.

Goldberg C. Emergency crews worry as hospitals say, “no vacancy.”. New York Times. 2000 Dec 17;39.

Orenstein JB. State of emergency. Washington Post., 2001:B1

Jeffrey NA. Who’s crowding emergency rooms. Right now it’s managed-care patients. Wall Street J B. 1999;1.

American College of Emergency Physicians. Crowding. Ann Emerg Med. 2006;47:585.

Gardner RL, Sarkar U, Maselli JH, Gonzales R. Factors associated with longer ED lengths of stay. Am J Emerg Med. 2007;25(6):643-50.

Morris ZS. Emergency Department crowding; towards an agenda for evidence based intervention. Emerg Med J 2012;29(6):460-6.

Van de Bogart L. Crisis in the emergency department: contributing factors and potential solutions, 2000.

Derlet R, Richards J. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35(1):83-5.

Richards J, Navarro M, Derlet R. Survey of directors of emergency departments in California on overcrowding. West J Med. 2000;172(6):385-8.

Richardson SK. Increasing patient numbers: the implications for New Zealand emergency departments. Accid Emerg Nurs. 1999;7(3):158-63.

Coast J, Inglis A, Frankel S. Alternatives to hospital care: what are they and who should decide? BMJ. 1996;312(7024):162-6.

Boushy D, Dubinsky I. Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient’s perspective. J Emerg Med. 1999;17(3):405-12.

Feferman I, Cornell C. How we solved the overcrowding problem in our emergency department. CMAJ: Canadian Med Associa J. 1989;140(3):273.

Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo Jr CA. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42(2):173-80.

Nerney MP, Chin MH, Jin L, Karrison TG, Walter J, Mulliken R, et al. Factors associated with older patients’ satisfaction with care in an inner-city emergency department. Ann Emerg Med. 2001;38(2):140-5.

Miro O, Antonio MT, Jimenez S, De AD, Sanchez M, Borras A, et al. Decreased health care quality associated with emergency department overcrowding. Europe J Emerg Med: J Europe Soc Emerg Med. 1999 ;6(2):105-7.

Liu S, Hobgood C, Brice JH. Impact of critical bed status on emergency department patient flow and overcrowding. Academic Emerg Med. 2003;10(4):382-5.

Cowan RM, Trzeciak S. Clinical review: emergency department overcrowding and the potential impact on the critically ill. Critical care. 2004;9(3):291

Lee-Lewandrowski E, Corboy D, Lewandrowski K, Sinclair J, McDermot S, Benzer TI. Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center: impact on test turnaround time and patient emergency department length of stay. Arch Pathol Laboratory Medicine. 2003;127(4):456-60.

Kubicek KA profile of non-urgent emergency department use in an urban setting, Pediat Emerg Care.2012:28:9(10):977- 84.

Lang T non-urgent care in hospital emergency dept in France Jr Epidemiol Commun Health. 1996:50(4):456-62.

Lega F, Mengoni A, Why non-urgent patients choose emergency over primary care services ?Health policy 2008,:88 (2-3):326-38.

Regional Unions of Physicians in Liberal Practice: White Paper on the Organization of Continuing Care in Liberal Medicine. Report for the Conference of Presidents of Regional Unions of Physicians in Liberal Practice. July 2001.

Gentile S, Vignally P, Durand AC, Gainotti S, Sambuc R, Gerbeaux P. Nonurgent patients in the emergency department? A French formula to prevent misuse. BMC health services research. 2010;10(1):66.

Philips H, Remmen R, De Paepe P, Buylaert W, Van Royen P. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call. BMC family practice. 2010;11(1):88.

Carret ML, Fassa AG, Kawachi I. Demand for emergency health service: factors associated with inappropriate use. BMC Health Services Research. 2007;7(1):131.

Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1)1-10.

Vieth TL, Rhodes KV. The effect of crowding on access and quality in an academic ED. The American journal of emergency medicine. 2006;24(7):787-94.

Van Der Linden C, Reijnen R, Derlet RW, Lindeboom R, Van Der Linden N, Lucas C, Richards JR. Emergency department crowding in The Netherlands: managers’ experiences. International J Emergency Medicine. 2013;6(1):41.

Nathen R. Systemic review of and solutions, emergency department crowding causes, effects and solutions. Am College Family Physicians.2008;52(2):126-37.

Sackett DL, Haynes RB, Tugwell P, Guyatt GH. Clinical epidemiology: a basic science for clinical medicine. Boston: Little, Brown; 1985 Jan.

Washington DL, Stevens CD, Shekelle PG, Henneman PL, Brook RH. Next-day care for emergency department users with nonacute conditions: a randomized, controlled trial. Ann Internal Med. 2002;137(9):707-14.

Kubicek KA profile of nonurgent emergency department use in an urban setting, Pediatric Emerg Care. 2012;9(10):977- 84.

Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ, Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013;209(1):1-10.

Rusen ID, Liston R, Wen SW, Bartholomew S. Special Report on Maternal Mortality and Severe Morbidity in Canada. Enhanced Surveillance. The Path to Prevention. Public Health Agency of Canada. 2004.