Validation of the National Emergency Department Overcrowding Score (NEDOCS) in a UK non-specialist emergency department

2020 ◽  
pp. emermed-2019-208836
Author(s):  
Duncan Hargreaves ◽  
Sophie Snel ◽  
Colin Dewar ◽  
Khushal Arjan ◽  
Piervirgilio Parrella ◽  
...  
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Perceived Risk ◽  
Temporal Correlation ◽  
Weighted Kappa ◽  
Physiological Data ◽  
Sampled Data ◽  
Rater Agreement ◽  
Emergency Department Overcrowding ◽  
National Emergency

IntroductionEmergency department (ED) crowding has significant adverse consequences, however, there is no widely accepted tool to measure it. This study validated the National Emergency Department Overcrowding score (NEDOCS) (range 0–200 points), which uses routinely collected ED data.MethodsThis prospective single-centre study sampled data during four periods of 2018. The outcome against which NEDOCS performance was assessed was a composite of clinician opinion of crowding (physician and nurse in charge). Area under thereceiver operating characteristic curves (AUROCs) and calibration plots were produced. Six-hour stratified sampling was added to adjust for temporal correlation of clinician opinion. Staff inter-rater agreement and NEDOCS association with opinion of risk, safety and staffing levels were collected.ResultsFrom 905 sampled hours, 448 paired observations were obtained, with the ED deemed crowded 18.5% of the time. Inter-rater agreement between staff was moderate (weighted kappa 0.57 (95% CI 0.56 to 0.60)). AUROC for NEDOCS was 0.81 (95% CI 0.77 to 0.86). Adjusted for temporal correlation, AUROC was 0.80 (95% CI 0.73 to 0.88). At a cut-off of 100 points sensitivity was 75.9% (95% CI 65.3% to 84.6%), specificity 72.1% (95% CI 67.1% to 76.6%), positive predictive value 38.2% (95% CI 30.7% to 46.1%) and negative predictive value 92.9% (95% CI 89.3% to 95.6%). NEDOCS underpredicted clinical opinion on Calibration assessment, only partially correcting with intercept updating. For perceived risk of harm, safety and insufficient staffing, NEDOCS AUROCs were 0.71 (95% CI 0.61 to 0.82), 0.71 (95% CI 0.63 to 0.80) and 0.70 (95% CI 0.64 to 0.76), respectively.ConclusionsNEDOCS demonstrated good discriminatory power for clinical perception of crowding. Prior to implementation, determining individual unit ED cut-off point(s) would be important as published thresholds may not be generalisable. Future studies could explore refinement of existing variables or addition of new variables, including acute physiological data, which may improve performance.

scholarly journals Patients Prefer Boarding in Inpatient Hallways: Correlation with the National Emergency Department Overcrowding Score

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
John R. Richards ◽  
Gal Ozery ◽  
Mark Notash ◽  
Peter E. Sokolove ◽  
Robert W. Derlet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Survey Study ◽  
Emergency Department Overcrowding ◽  
Urban University ◽  
Male Patients ◽  
University Level ◽  
Level I ◽  
National Emergency ◽  
Ed Crowding

Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS).Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted.Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0–200) was for patients preferring inpatient boarding, for ED boarding, and without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS.Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

scholarly journals STRATEGI UNTUK MENGATASI KEPADATAN UNIT GAWAT DARURAT (UGD): TINJAUAN PUSTAKA

2021 ◽  
Vol 7 (1) ◽  
pp. 41-50
Author(s):  
Rosmini Rasimin ◽  
Yuliana Syam ◽  
Rosyidah Arafat ◽  
Sintawati Majid
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Google Scholar ◽  
Electronic Database ◽  
Emergency Department Overcrowding ◽  
National Emergency

Latar Belakang: Unit gawat darurat (ED) sebagai pintu gerbang penanganan awal pasien dengan kegawatdarutatan berisiko mengalami Kepadatan. Tujuan  literature review ini adalah untuk mencari strategi yang tepat untuk mengatasi kepadatan di ED. Metode yang digunakan  yaitu pencarian pada electronic database seperti Pubmed, DOAJ, dan google scholar, menggunakan kata kunci Crowding AND Emergency Department, awal ditemukan 1160 artikel,15 artikel dimasukkan setelah melalui proses screening. Hasil review menyajikan penyebab kepadatan di ED, alat ukur, efek yang ditimbulkan, dan srategi penaganan kepadatan di ED. Kesimpulan, lama tinggal dan keterlambatan pemeriksaan penunjang mempengaruhi kepadatan, system informasi serta pengelompokan pasien dapat menurunkan kepadatan, National Emergency Department Overcrowding Scale (NEDOCS) direkomendasikan untuk mengukur skala kepadatan di ED.

Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage

2020 ◽  
pp. emermed-2019-208633
Author(s):  
William Shrier ◽  
Colin Dewar ◽  
Piervirgilio Parrella ◽  
David Hunt ◽  
Luke Eliot Hodgson
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Predictive Value ◽  
Kappa Statistic ◽  
Roc Curves ◽  
Weighted Kappa ◽  
Medical Doctor ◽  
Triage Nurse ◽  
Inpatient Mortality ◽  
Clinical Frailty Scale

AimTo determine the agreement and predictive value of emergency department (ED) triage nurse scoring of frailty using the Rockwood Clinical Frailty Scale (CFS) when compared with inpatient medical assessment using the same scale.MethodsProspective, dual-centre UK-based study over a 1-year period (1 April 2017 to 31 March 2018) of CFS recorded digitally at nursing triage on ED arrival and on hospital admission by a medical doctor. Inclusion criteria were emergency medical admission in those aged ≥65 staying at least one night in hospital with a CFS completed in both ED and at hospital admission. Agreement between ED triage nurse and inpatient hospital physician was assessed using a weighted Kappa statistic and Spearman’s correlation coefficient. The ability of the ED to diagnose frailty (defined by a CFS ≥5) was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curves. At both time points the ability of the CFS to predict inpatient mortality was also assessed.ResultsFrom 29 211 admissions aged ≥65 who stayed at least one night in hospital, 12 385 (42.3%) were referred from the ED. Of the ED referrals, 8568 cases (69.2%) were included with paired CFS performed. Median age was 84 (IQR 77 to 89) with an inpatient mortality of 6%. Median CFS in ED was 4 (3 to 5) and on hospital admission 5 (4 to 6). Agreement between the ED CFS and admission CFS was weak (Kappa 0.21, 95% CI 0.19 to 0.22, rs 0.366). The area under the ROC curve (AUC) was 0.67 (95% CI 0.66 to 0.68) for the ED CFS ability to predict an admission CFS ≥5. To predict inpatient mortality the ED CFS AUC was 0.56 (0.53 to 0.59) and admission CFS AUC 0.70 (0.68 to 0.73).ConclusionAgreement between ED CFS and inpatient CFS was found to be weak. In addition the ability of ED CFS to predict clinically important outcomes was limited. NPV and PPV for ED CFS cut-off value of ≥5 were found to be low. Further work is required on the feasibility, clinical impact and appropriate tools for screening of frailty in EDs.

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