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.
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Article Info
Publication History
Published online: August 02, 2014
Accepted:
July 26,
2014
Received in revised form:
July 7,
2014
Received:
June 7,
2014
Footnotes
☆Source(s) of support in the form of equipment, drugs, or grants (including grant numbers): None.
☆☆Competing interests: N/A.
★Author contributions: HW and RDR conceived the study and developed the design in consultation with all of the authors. KB, CAH, BB, KW, and NCW assembled the data set and collected the data. HW, RDR, RDJ, and NRZ conducted the statistical analyses and drafted the article, and all authors read and approved the final manuscript. HW takes responsibility for the manuscript as a whole.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
