Do health care professionals’ perceptions help to measure the degree of overcrowding in the emergency department? A pilot study in an Italian University hospital

Abstract

Background Overcrowding in emergency departments (EDs) is internationally recognized as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of overcrowding, including increased length of stay, mortality and cost per admission. This study measures overcrowding in EDs through health care professionals’ perceptions of it, comparing the results with the NEDOCS score, an objectively validated measurement tool and describing meaningful tools and strategies used to manage ED overcrowding. Methods This single-centre prospective, observational, pilot study was conducted from February 19th to March 7th, 2018 at the ED in the University Hospital of Ferrara, Italy to measure the agreement of the NEDOCS, comparing objective scores with healthcare professionals’ perception of overcrowding, using the kappa statistic assessing linear weights according to Cohen’s method. The tools and strategies used to manage ED overcrowding are described. Results Seventy-two healthcare professionals (66.1% of 109 eligible subjects) were included in the analyses. The study obtained a total of 262 surveys from 23 ED physicians (31.9%), 31 nurses (43.1%) and 18 nursing assistants (25.0%) and a total of 262 NEDOCS scores. The agreement between the NEDOCS and the subjective scales was poor (k = 0.381, 95% CI 0.313–0.450). Conclusions The subjective health care professionals’ perceptions did not provide an adequate real-time measure of the current demands and capacity of the ED. A more objective measure is needed to make quality decisions about health care professional needs and the ability to manage patients to ensure the provision of proper care.

NEDOCS: is it really useful for detecting emergency department overcrowding today?

“…[ 5 ] Also, Strada et al and Anneveld et al found a weak correlation between the occupational groups similar to our study. [ 23 , 27 ] We could not find a relationship or correlation between occupational groups and ED overcrowding perception in the statistical analyses, but all the occupational groups make similar evaluations in the perception of the ED overcrowding. All the occupational groups evaluated the ED overcrowding mostly as “busy”.…”

“…Similarly to our results, Strada et al and Romero et al, compare NEDOCS score and health care professionals’ perceptions and found that the NEDOCS score overestimates the ED crowdedness. [ 23 , 24 ] Also, Wang et al, found that the NEDOCS score is not applicable for extremely high-volume ED setting. [ 5 ] It is possible to assert that the NEDOCS score is not a suitable scoring system for EDs, which are similar to our ED.…”

Diagnostic anticipation to reduce emergency department length of stay: a retrospective cohort study in Ferrara University hospital, Italy

“… Abbreviations: DA = Diagnostic Anticipation; LOS = Length of Stay; SD = Standard Deviation; NEDOCS =National ED Overcrowding Study Score [ 15 ] at triage registration; min = minutes †calculated through Pearson’s χ2 test for categorical variables and T-Student test for continuous variables …”

“…ED crowding was estimated for each visit through the National ED Overcrowding Study (NEDOCS) score [ 14 ]. The NEDOCS score is one tool that is used in Emilia Romagna Region (Italy) and has been found to assess ED overcrowding with relatively high consistency, the NEDOCS was automatically calculated every hour at real-time points [ 15 ]. The statistical significance of the differences between intervention and non-intervention weeks was evaluated using Fisher’s exact test for categorical variables, and t-test for continuous variables.…”

Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

“…Table 1 Nurse-initiated blood test ordering at triage, based on a physician-approved diagnostic algorithm. A multidisciplinary team including the hospital risk manager, ED physicians and nurses, laboratory physicians and IT technicians defined the standard operating procedure: whenever an eligible patient was accepted to ED triage, the nurse selected the above listed blood tests within 15 minutes [14].…”