NEDOCS Score for Emergency Department Overcrowding
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
Pearls / Pitfalls
The NEDOCS scoring system was created to assess and quantify ED overcrowding. NEDOCS only targeted large, academic trauma centers. CEDOCS was developed several years later to specifically target community EDs, which have slightly different variables that affect their crowding. 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