Fellow (PGY-6) in Pediatric Emergency Medicine Nationwide Children's Hospital GALENA, Ohio, United States
Background: Overcrowding occurs when demand for services outstrips resources and is a national crisis in pediatric emergency departments (ED) threatening patient safety. A widely used scoring system, National Emergency Department Overcrowding Score (NEDOCS), which was developed via a multi-center collaboration of adult academic EDs, indicates a need for additional resources and diversion status. Multiple key factors contribute to a numerical range (0-200), which is then further categorized into: not busy (0), busy (40), extremely busy but not overcrowded (80), overcrowded (120), severely overcrowded (160), and dangerously overcrowded (200). Overcrowding has been correlated with established metrics in adult studies: left without being seen (LWBS), ED and hospital length of stay (LOS), and 72-hour ED return visits. NEDOCS has been studied and utilized extensively in adult EDs but applicability to academic tertiary care pediatric EDs has not been previously investigated.
Objective: To determine the association between NEDOCS score and established metrics (LWBS, ED LOS, Hospital LOS, 72-hour ED return visits) from 2016-2019, in a large academic tertiary care pediatric ED.
Design/Methods: Retrospective ED metrics and NEDOCS were obtained from 2016-2019 using hospital administrative records. Descriptive statistics and multivariate analyses were performed to evaluate the association of specific outcome variables (ED metrics) to the predictor measure (NEDOCS). A component in the original NEDOCS was number of patients on ventilators; frequency of mechanical ventilation is less in children, therefore was replaced by number of patients in resuscitation rooms as a better indicator of acuity in this setting.
Results: LWBS rates and ED LOS increased as NEDOCS increased, while hospital LOS decreased with increase in NEDOCS. On average, odds of LWBS doubled with NEDOCS category, controlling for other covariates (OR 2.03; 95% CI: 2.00-2.06; p < 0.05). ED LOS was associated with increase of 24 minutes (p < 0.001), and hospital LOS decreased by 100 minutes as NEDOCS increased by one category (p < 0.01). The odds of 72-hour return visits increased by 6% when NEDOCS increased by one category, controlling for other covariates in the sample (OR: 1.06; 95% CI: 1.05-1.07; p < 0.05).Conclusion(s): NEDOCS is positively associated with ED LOS, LWBS and 72-hour return visits, consistent with adult data. Further investigation is needed to elucidate the negative association between NEDOCS and hospital LOS. This study illustrates the utility of NEDOCS as a measure of overcrowding in an academic tertiary care pediatric ED.
.jpg "Yamini Jadcherla, MD photo")