Overcrowding in an Emergency Department of a Referral Centre in Nigeria: A Study of National Orthopaedic Hospital, Igbobi, Lagos

Abstract

Background: An emergency department (ED) is where acute cases report and require urgent and intensive care. The ED of National Orthopaedic Hospital, Igbobi, Lagos is constantly overcrowded and may be impacting the nursing care that is provided in the unit. Objective: To identify triggers to ED overcrowding in the study hospital and determine influence of overcrowding in nursing care of patients. Methods: In this cross- sectional study, all the thirty nurses working in ED participated in the survey. A self-administered questionnaire was used to collect quantitative data and Focus Group Discussion (FGD) was employed for qualitative data. The questionnaire was administered to thirty nurses and 100% return rate was achieved. Data was analysed using IBM SPSS Statistics 20 and relative importance index (RII) and its ranking (R) was used to establish the relative importance of the various triggers identified as responsible for overcrowding. Results: Result revealed severe cases managed in ED (76.7%), patients stay longer than expected in the ED (80.0%), lack of space (76.7%), lack of ED equipment e.g. stretchers (73.3%), insufficient beds in the ED (66.7%), heavy patient inflow and the hospital policy of not rejecting patients, and patients’ delay in accomplishing their laboratory investigations as triggers of ED overcrowding. The study participants identified increased nurse workload (RII=0.880; R=1), strain in nurse and patients’ relations relationship (RII=0.75= 2.0) and long patient wait (RII=0.747; R=3.0) as three most outstanding influence of overcrowding. Conclusion: The obvious overcrowding in this ED is triggered by the chronic and non-emergency cases accessing the ED, as well as limited bed space which further drives overcrowding increasing nurse work load, frustration and lack of cooperation by the patients.