Critiquing Quantitative Study: Effect of Emergency Department Crowding on Outcomes of Admitted Patients

Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., ... & Asch, S. M. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of emergency medicine, 61(6), 605-611.

Research Problem and Purpose

The purpose of the research was to assess the association between emergency department crowding with consequent outcome in the hospitalized patients. The research problem poor quality of care caused by emergency department crowding.

Hypotheses and Research Questions

No hypotheses or research questions were mentioned for the research but the research mentions that examines the perception that emergency department crowding leads to poor quality of care

Literature Review

The literature review of the study is current and also relevant to the study. There is evidence that the authors critiqued the literature. There is an integrated summary of the current knowledge base concerning the topic of research.

Theoretical or Conceptual Framework

There is no conceptual framework for the study.

Population

The study examined 995,379 emergency department visits that resulted in admissions to 187 hospitals.

Protection of Human Research Participants

The study does not discuss the methods used to protect the human subjects.

Research Design

The study performed a retrospective cohort analysis of patients in 2007 through emergency departments of nonfederal hospitals in California.

Instruments and Strategies for Measurement

The study used hierarchy regression models to control for hospital fixed effects, primary diagnosis, patient comorbidities, time variables, and demographics. There was no information provided regarding the validity and reliability of measurement instruments.

Data Collection

Data was collected on admission-level characteristics that can be related to the outcomes of the study including ethnicity race, sex, race, primary discharge diagnosis, comorbidities, time indicators, and age.

Data Analysis

The study assessed for baseline difference with hospital-level fixed effects models for continuous variables, in descriptive analyses of hospital admissions stratifies buy presence of high emergency department overcrowding. These methods were appropriate for the study design.

Interpretation of Results

The results of the data analysis were that emergency department crowding is associated with a large cohort of admitted patients, length of stay and mortality. Sufficient information was given to interpret the results of the data analysis. High ED crowding was associated with 5% greater odds of inpatient death (95% CI 2% to 8%), 0.8% longer hospital length of stay (95% CI 0.5% to 1%), and 1% increased costs per admission (95% CI 0.7% to 2%).

Discussion of Findings

The findings of the study were the expected findings, and they were consistent with the previous studies. The patients that were admitted to the emergency department during the periods of high emergency department crowding died more often than similar patients admitted to the same hospital at the time when emergency department was not crowded.

Limitations

The study was subject to potential limitations including the fact that ambulance division hours may be an imperfect measure of emergency department crowding. Additionally, the results of the study are robust to the timing of in-hospital deaths and specification of the emergency department crowding measure.

Implications

The researchers demonstrate that crowding results in increased cost, length of stay and mortality.

Recommendations

Emergency department crowding should be addressed as an important issue by the Institute of Medicine.

Research Utilization in Your Practice

The connection between emergency department crowding and patient outcomes strengthens the argument to end the practice of emergency department overcrowding.

Critiquing Qualitative Study

Coughlan, M., & Corry, M. (2013). The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland: a qualitative descriptive study. Accident and Emergency nursing, 15(4), 201-209.

Research Problem and Purpose

Describe the experiences patients and their relatives who have spent 12 hours or more in an A&E awaiting admission to hospital.

Hypotheses and Research Questions

There were no hypotheses or research questions outlined in the study.

Literature Review

The literature review of the study is current and also relevant to the study. There is evidence that the authors critiqued the literature. There is an integrated summary of the current knowledge base concerning the topic of research.

Theoretical or Conceptual Framework

There was no conceptual framework discussed in the study.

Population

The study initially anticipated that ten relatives and ten patients would be interviewed. The inclusion criteria were that the patients were at least 18 years old, that they were fluent in English and that they were a patient or the relative of a patient.

Protection of Human Research Participants

Before the study was conducted the participants were given both verbal and written explanations concerning the purpose of the study and the data would be used, how confidentiality would be maintained and how their identities would be maintained as anonymous.

Research Design

The research uses a qualitative descriptive design.

Instruments and Strategies for Measurement

Four patients and three relatives participated in the study.

Data Collection

Data was collected using a semi-structured interview that was conducted with the assistance of an interview guide.

Data Analysis

Content analysis was used to summarize the collected data.

Findings

The study's findings were that long waiting times at accident and emergency departments as a result of overcrowding reduced the quality of care offered to patients and annoyed patients and their relatives.

Discussion of Findings

The findings discussed were those excepted by the study. The patient who waited longest was in the emergency department for five days before being transferred to a ward.

Limitations

There were no limitations of the research mentioned.

Implications

The study demonstrated that staff at the accident and emergency department are undermanned and overworked.

Recommendations

Waiting times at the emergency department should be reduced by a maximum of 6 hours from admission to discharge or transfer.

Better communication system with a liaison person to advise them about the expected duration in the emergency department.

Research Utilization in Your Practice

The emergency department was described as resembling a disaster zone or a hospital scene from a third world nation. These descriptions could be used be used to improve the conditions of emergency rooms.

Response to The Claim That Qualitative Research Is Not Real Science

This paper agrees that Qualitative research is not real science. There are four major criteria which determine if research approach is scientific or not. These criteria include parsimony, precision, falsifiability, and replicability. Replicability is the degree to which a research approach can be repeated and the same results obtained. Qualitative approach meets the replicability criterion since its studies can be replicated many times, and the initial results can be correlated with numerous future studies (Ritchie et al., 2013). Falsifiability is the extent to which a research approach ensures that data is stated in a manner so it can be rejected by proving data wrong to guarantee that there is no confirmation bias. The qualitative approach cannot meet this criterion because its studies are hard to falsify. Precision is the degree to which the hypotheses of a study are stated precisely to allow researchers to replicate the study. The qualitative approach does not fulfill this criterion because its studies do not have hypotheses.

Parsimony embroils the researcher applying simple explanations of sets of observations to prevent psychologists from developing inexplicable theories (Denzin & Lincoln, 2011). Qualitative approach fulfills this criterion because the findings of studies can be condensed to their simplest form with the main aim of explaining the cause of a certain behavior. Although the qualitative approach is relevant in research, it lacks scientific accuracy since it does not fulfill the scientific requirements of being precise and falsifiable, hence it can be considered not real science.

Contrasting Information Gotten from The Research Approaches

The information obtained from quantitative approach is in quantities, and it can be measured or written down in numbers (Denzin & Lincoln, 2011). On the other hand, information obtained from qualitative research is regarding qualities and cannot be measured (Taylor, Bogdan, & DeVault, 2015). Qualitative information is data in which the classification of objects is based on properties and attributes. While quantitative data is the type of data that is expressed numerically. In the qualitative research approach, qualitative data was used to explore the phenomenon the effect of overcrowding in accident and emergency department overcrowding on patients and their relatives (Bryman, 2015). In the quantitative approach, the quantitative data provided conclusive findings of the experience of patients who were admitted to hospitals with crowded emergency departments.

General Insights That both Quantitative and Qualitative Studies Can Provide to Researchers

Quantitative studies provide quantifiable insights about a phenomenon being investigated. It provides values of measurements regarding the phenomenon being researched. For instance, the study that uses the quantitative approach provided results concerning the effect of emergency department crowding in qualitative form such as the high emergency department crowding was associated with 5% greater odds of inpatient death (95% CI 2% to 8%), 0.8% longer hospital length of stay (95% CI 0.5% to 1%), and 1% increased costs per admission (95% CI 0.7% to 2%). On the other hand, qualitative research provides descriptive detailed and vivid insights about the phenomenon being studied (Ritchie et al., 2013). For instance, the qualitative study that was reviewed described its findings as long waiting times at accident and emergency departments as a result of overcrowding reduced the quality of care offered to patients and annoyed patients and their relatives.

Advantages and Disadvantages of the Research Approaches

The quantitative research utilizes survey methods across a large sample, facilitating the generalization of findings of research to an entire population. This approach enabled the gathering of information from a comparatively larger number of participants. For instance, the research that utilized the quantitative approach studied 995,379 emergency department visits. Quantitative research conforms to statistical methods which aloe the determination of relations between variables (Bernard & Bernard, 2012). For example, in the quantitative research, the relationship between emergency department overcrowding and subsequent outcomes in hospitalized patients. One of the disadvantages of the quantitative approach is that it does not provide an in-depth of the phenomenon being investigated. Additionally, there is difficulty in recognizing un-researched and new phenomena when using quantitative approach.

Qualitative research deeply explores the understanding, feelings, perceptions, and behavior of participants in investigating the phenomenon (Christensen et al., 2011). For instance, in the study using the qualitative approach, the participants were allowed to explain their feelings about their experie...