PEDOCS Score for Pediatric 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

PEDOCS was created as an improved analysis over the NEDOCS scoring system; both assess and quantify ED overcrowding. PEDOCS was developed specifically with pediatric 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. Points to keep in mind: The PEDOCS score should have additional validation done to verify its generalizabilty to other 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.

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