The NEDOCS tool to measure crowding at an academic Emergency Department

Abstract Background: This is the first study to validate the National Emergency Department Overcrowding Study (NEDOCS) tool as a quantitative tool for assessing crowding at the Emergency Department (ED) of a Dutch level I trauma center at an academic hospital with a patient volume of 22.000 every year. Methods: This was a prospective observational study performed between April 20th, 2017 and June 19th, 2017 at the ED of the Radboud University Medical Center (Radboudumc), a level I academic hospital in the Netherlands. The NEDOCS score was generated every 30 minutes during the study period of 2 months. During this study period the charge nurse and emergency physician (EP) both filled in a questionnaire 5 time a day to register perceived crowding and work load. The correlation and agreement between the perceived crowding by the ED staff members and the NEDOCS score were calculated. Results: The NEDOCS score was measured 2,887 times, with a median score of 16.15. A positive correlation between the NEDOCS score and the perceived crowding was measured (Spearman’s correlation coefficient 0.715). There was low agreement between the NEDOCS score and the perceived crowding.Conclusion: The NEDOCS tool shows a positive correlation with the perceived crowding by the ED staff making it a potential tool for national crowding management. However, there is a low agreement in its current form. Future studies should be performed to optimize the NEDOCS tool and usage.