Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Development of teaching resources for physical modelling community

Physical modelling of interesting geotechnical problems has helped clarify behaviours and failure mechanisms of many civil engineering systems. Interesting visual information from physical modelling can also be used in teaching to foster interest in geotechnical engineering and recruit young researchers to our field. With this intention, the Teaching Committee of TC2 developed a web-based teaching resources centre. In this paper, the development and organisation of the resource centre using Wordpress. Wordpress is an open-source content management system which allows user content to be edited and site administration to be controlled remotely via a built-in interface. Example data from a centrifuge test on shallow foundations which could be used for undergraduate or graduate level courses is presented and its use illustrated. A discussion on the development of wiki-style addition to the resource centre for commonly used physical model terms is also presented. © 2010 Taylor & Francis Group, London.