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. 2022 Aug 9;22(1):143.
doi: 10.1186/s12873-022-00703-8.

A case study to investigate the impact of overcrowding indices in emergency departments

Giovanni Improta  1   2 , Massimo Majolo  3 , Eliana Raiola  3 , Giuseppe Russo  3 , Giuseppe Longo  3 , Maria Triassi  4   5
Affiliations

A case study to investigate the impact of overcrowding indices in emergency departments

Giovanni Improta et al. BMC Emerg Med. .

Abstract

Background: Emergency department (ED) overcrowding is widespread in hospitals in many countries, causing severe consequences to patient outcomes, staff work and the system, with an overall increase in costs. Therefore, health managers are constantly looking for new preventive and corrective measures to counter this phenomenon. To do this, however, it is necessary to be able to characterize the problem objectively. For this reason, various indices are used in the literature to assess ED crowding. In this work, we explore the use of two of the most widespread crowding indices in an ED of an Italian national hospital, investigate their relationships and discuss their effectiveness.

Methods: In this study, two of the most widely used indices in the literature, the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Working Index (EDWIN), were analysed to characterize overcrowding in the ED of A.O.R.N. "A. Cardarelli" of Naples, which included 1678 clinical cases. The measurement was taken every 15 minutes for a period of 7 days.

Results: The results showed consistency in the use of EDWIN and NEDOCS indices as measures of overcrowding, especially in severe overcrowding conditions. Indeed, in the examined case study, both EDWIN and NEDOCS showed very low rates of occurrence of severe overcrowding (2-3%). In contrast, regarding differences in the estimation of busy to overcrowded ED rates, the EDWIN index proved to be less sensitive in distinguishing these variations in the occupancy of the ED. Furthermore, within the target week considered in the study, the results show that, according to both EDWIN and NEDOCS, higher overcrowding rates occurred during the middle week rather than during the weekend. Finally, a low degree of correlation between the two indices was found.

Conclusions: The effectiveness of both EDWIN and NEDOCS in measuring ED crowding and overcrowding was investigated, and the main differences and relationships in the use of the indices are highlighted. While both indices are useful ED performance metrics, they are not always interchangeable, and their combined use could provide more details in understanding ED dynamics and possibly predicting future critical conditions, thus enhancing ED management.

Keywords: ED evaluation indices; Emergency department work index (EDWIN); National Emergency Department Overcrowding Scale (NEDOCS); Overcrowding in emergency department (ED).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
NEDOCS index values for the emergency department at the hospital “A. Cardarelli” hospital over a period of 7 days
Fig. 2
Fig. 2
NEDOCS index values for March 14th, 2016
Fig. 3
Fig. 3
EDWIN index values for the emergency department at the hospital “A. Cardarelli” hospital over a period of 7 days
Fig. 4
Fig. 4
EDWIN index values for March 14th, 2016
Fig. 5
Fig. 5
Comparison between the Emergency Department Work Index (EDWIN) results and the National Emergency Department Overcrowding Scale (NEDOCS) results for a selected day (March 14th, 2016). A linear regression curve (dashed line) is displayed to show the slight monotonic relationship between the two indices
See this image and copyright information in PMC

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