CEDOCS Score for Emergency Department Overcrowding

CEDOCS Score Calculator
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Estimates severity of overcrowding in community emergency departments.

Why Use

Providing an objective, quantitative score can help EDs and their hospitals provide appropriate resources to the ED and rest of the hospital to reduce delays in care and boarding, which have been shown to have significant impacts on patient morbidity and mortality.

When to Use

Many EDs are using these scores every shift or at times on shift with drastic changes in crowding (large influx of patients, for example).

Formula

CEDOCS Score = –29.53 + (3.14 x critical care patients in the ED) + (0.52 x waiting time of longest admitted patient) + (1.14 x number of patients in waiting room) + (20.55 x ratio of total ED patients to number of ED beds) + (0.00124 x ED visits per year) + A + B + C + D (additional variables based on ED visits per year) as follows: Threshold Additional variables* If ED visits per year ≥18,811 A = – [(1.09 x 10 -12 ) x (ED visits per year – 18,811) 3 ] If ED visits per year ≥43,012 B = [(8.18 x 10 -12 ) x (ED visits per year – 43,012) 3 ] If ED visits per year ≥49,466 C = – [(8.18 x 10 -12 ) x (ED visits per year – 49,466) 3 ] If ED visits per year ≥67,273 D = [(1.08 x 10 -12 ) x (ED visits per year – 67,273) 3 ] *Include all variables in scoring where “ED visits per year” is greater than or equal to the threshold. If “ED visits per year” does not meet the threshold requirement, count variable as 0. For example, if ED visits per year is ≥43,012, final CEDOCS Score = CEDOCS Score + A + B. Note: Final CEDOCS Score is multiplied by the scaling factor specified. If no scaling factor or a scaling factor of 0 is specified, final CEDOCS Score is multiplied by 2.

Pearls / Pitfalls

CEDOCS was created as an improved analysis over the NEDOCS scoring system; both assess and quantify ED overcrowding. CEDOCS was developed specifically with community emergency departments in mind. NEDOCS only targeted large, academic trauma centers. Interestingly, its score was calibrated by comparing “busy-ness” to ratings by emergency physicians and emergency department charge nurses. CEDOCS is calibrated to score 0-100, but usually the score is doubled so it can be compared to NEDOCS (0-200). CEDOCS appears to be valid at EDs with at least 18,000 patients per year. Points to keep in mind: These scores are “best guess” estimates to objectify over-crowding but will not always be able to account for all causes of over-crowding. For example, as mentioned by its authors, “‘psych patients awaiting admission’ were not a problem in the particular hospitals in the original NEDOCS study but have become more of a recent problem in community-based hospitals.”

Management

Many hospitals have developed “surge plans” similar to disaster plans that provide additional resources to the hospital and ED when an ED goes above a certain score threshold (often level 4 or 5 - >100 or >140).

Advice

Perform a crowding score assessment every shift, as well as at times of large influxes of patients to the ED.

More Information

Score interpretation: Level Score Interpretation Level 1 1-20 Not busy Level 2 21-60 Busy Level 3 61-100 Extremely busy but not overcrowded Level 4 101-140 Overcrowded Level 5 141-180 Severely overcrowded Level 6 181-200 Dangerously overcrowded

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