J Korean Soc Emerg Med.  2006 Oct;17(5):377-384.

Analysis of Overcrowding in a Local Emergency Department using National Emergency Department Overcrowding Scale (NEDOCS)

• Choi HS
• Lee KW

Abstract

PURPOSE: Emergency Department (ED) overcrowding is a national problem and the quantitative measure of ED overcrowding is required. National Emergency Department Overcrowding Scale (NEDOCS) was designed for objective evaluation and quantification of ED overcrowding based on the standard of emergency providers' opinion. NEDOCS is a simple screening tool that can be used to determine the degree of ED overcrowding easily. The purpose of this study was to analyze the overcrowding in a local emergency department using NEDOCS.
METHODS
This was a prospective study that medical record obtained from ED census and Order Communicating System (OCS). Three study periods were 1st study-period (from 14 March 2005 to 3 April 2005), 2nd study-period (from 27 October 2005 to 16 November 2005) and 3rd study-period (from 1 March 2006 to 21 March 2006). Sixparameters, the admission time (Admit time), the patient index (Patindex), the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), were used to estimate overcrowding. The comparison between weekday and weekend overcrowding was assessed by using t-test. Also, the same statistical method was used to analyze differences between the 1st study-period and the 3rd study-period. The relationship between NEDOCS and six-parameters was tested by using Pearson's correlation analysis and multiple linear regression analysis.
RESULTS
The total number of patients was 4,280. Of these, 2,403 (56.1%) were male and 1,877 female (43.9%). This study showed that ED overcrowding in weekend increased significantly. However, there was no significant change of ED overcrowding during 1 year (between the 1st study-period and the 3rd study-period). NEDOCS has a positive correlation with the Patindex (r=0.856, p=0.000), the BR (r=0.734, p=0.000), the PR (r=0.610, p=0.000), and the DV (r=0.559, p=0.000). Multiple linear regression analysis showed that Patindex was the only independent factor of NEDOCS (beta=0.854, p=0.000, adjusted R2=0.724).
CONCLUSION
In conclusion, the NEDOCS was well correlated with overcrowding parameters and the only independent factor of NEDOCS was Patindex.

Keyword

Scales; Crowding; Emergenices Hospital department

MeSH Terms

Censuses
Crowding
Emergencies*
Emergency Service, Hospital*
Female
Humans
Linear Models
Male
Mass Screening
Medical Records
Prospective Studies
Weights and Measures