VALIDATION OF THE SHORT FORM OF THE INTERNATIONAL CROWDING MEASURE IN EMERGENCY DEPARTMENTS (ICMED): INTERNATIONAL STUDY
Bibliographic record
Abstract
Objectives & Background There is little consensus on the best way to measure emergency department crowding. We have previously developed a consensus based measure, the International Crowding Measure in Emergency Departments (ICMED). This measure has both flow and non-flow items, and also contains items which measure Input, Throughput and Output. We aimed to externally validate a short form of the ICMED against emergency physician's perceptions of crowding and danger across a wide variety of Emergency Departments. Face validity is important to support implementation of any measure Methods We performed an observational validation study in seven emergency departments in five different countries. We recorded sICMED observations and the most senior available emergency physician's perceptions of crowding and danger at the same time. We performed a times series regression model to account for clustering and correlation. Results 397 data points were analysed. The sICMED showed moderate positive correlations with emergency physician's perceptions of crowding r=0.4110, p<0.05) and danger (r=0.4566, p<0.05.) There was considerable variation in the performance of the sICMED between different emergency departments. The sICMED was only slightly better than measuring occupancy or emergency department boarding time. Conclusion The short form of the ICMED has moderate face validity in measuring crowding. This is an important first step in validating this measure. The measure performs less well in Emergency Departments that are constantly crowded. Figure 1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.046 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".