The inaccuracy of determining overcrowding status by using the National ED Overcrowding Study Tool

Abstract Background Emergency department (ED) crowding has become more common, and perceptions of crowding vary among different health care providers. The National Emergency Department Overcrowding Study (NEDOCS) tool is the most commonly used tool to estimate ED crowding but still uncertain of its...

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Bibliographic Details
Published in:The American journal of emergency medicine 2014-10, Vol.32 (10), p.1230-1236
Main Authors: Wang, Hao, MD, PhD, Robinson, Richard D., MD, Bunch, Kellie, RN, BSN, Huggins, Charles A., MD, Watson, Katherine, RN, BSN, Jayswal, Rani D., MPH, White, Noah C., MD, Banks, Brett, DO, Zenarosa, Nestor R., MD
Format: Article
Language:English
Subjects:
Adult
Attitude of Health Personnel
Crowding
Emergency
Emergency medical care
Emergency Medicine
Emergency Nursing
Emergency Service, Hospital - statistics & numerical data
Emergency services
Female
Hospitals
Hospitals, High-Volume - statistics & numerical data
Hospitals, Urban - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Tertiary Care Centers
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Summary:Abstract Background Emergency department (ED) crowding has become more common, and perceptions of crowding vary among different health care providers. The National Emergency Department Overcrowding Study (NEDOCS) tool is the most commonly used tool to estimate ED crowding but still uncertain of its reliability in different ED settings. Objective The objectives of this study are to determine the accuracy of using the NEDOCS tool to evaluate overcrowding in an extremely high-volume ED and assess the reliability and consistency of different providers’ perceptions of ED crowding. Material and methods This was a 2-phase study. In phase 1, ED crowding was determined by the NEDOCS tool. The ED length of stay and number of patients who left without being seen were analyzed. In phase 2, a survey of simulated ED census scenarios was completed by different providers. The interrater and intrarater agreements of ED crowding were tested. Results In phase 1, the subject ED was determined to be overcrowded more than 75% of the time in which nearly 50% was rated as severely overcrowded by the NEDOCS tool. No statistically significant difference was found in terms of the average length of stay and the number of left without being seen patients under different crowding categories. In phase 2, 88 surveys were completed. A moderate level of agreement between health care providers was reached ( κ = 0.5402, P < .0001). Test-retest reliability among providers was high ( r = 0.8833, P = .0007). The strength of agreement between study groups and the NEDOCS was weak ( κ = 0.3695, P < .001). Conclusion Using the NEDOCS tool to determine ED crowding might be inaccurate in an extremely high-volume ED setting.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2014.07.032