A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective…

Cohort studyFrontiers in pediatrics· 2026

A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.

Johanna T Meßner, Dennis Freuer, Christine Meisinger … Florian Weber

Emergency Department FlowCohort studyQ1IF 2.2

Patient-to-nurse ratio around 2.2 predicted crowding-related departures in pediatric emergency department

A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.

Johanna T Meßner … Florian Weber

Frontiers in pediatrics · 2026

Background

Emergency department (emergency department) overcrowding is increasingly observed worldwide and is associated with impaired care quality and patient outcomes.

Purpose

This study aimed to derive a locally applicable operational definition of pediatric EDs overcrowding reflecting the care structures and demand patterns of the University Hospital Augsburg (UKA) pediatric EDs and supporting future validation, prediction, and intervention studies.

Methods

We conducted an 8-year retrospective cohort study (2017-2024) including 141,008 pediatric EDs visits by children aged 0-18 years at UKA.

n = 20 patients

Results

2.2

About 2.2 patients per nurse marked the threshold linked to patients leaving unseen.

n = 20 patients

More results

The ps-ratio showed the strongest correlations with LOS ( r = 0.612) and leaving without being seen ( r = 0.428).

Time-series modeling for 2020-2024 showed a nonlinear ps-ratio trend and a marked level shift during the COVID-19 lockdown period.

More results

Pediatric EDs demand was characterized by high self-referral rates, predominantly lower-acuity presentations, weekend and holiday clustering, and temporal fluctuations in visit volume.

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Conclusion · 1 of 3

Locally derived operational definitions may improve interpretation of pediatric EDs overcrowding by linking patient demand to staffing capacity and local care structures.

Conclusion · 2 of 3

In the OACS + cohort, the ps-ratio emerged as a staffing-sensitive, clinically interpretable operational marker.

Conclusion · 3 of 3

The proposed threshold should be considered a locally derived exploratory benchmark requiring external validation before application elsewhere.

A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.

A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.

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