Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Results of the National ED Overcrowding Study (NEDOCS)

Weiss, Steven J.; Derlet, Robert W.; Arndahl, Jeanine; Ernst, Amy A.; Richards, John R.; Fernández-Frankelton, Madonna; Schwab, Robert; Stair, Thomas O.; Vicellio, Peter; Levy, David; Brautigan, Mark W.; Johnson, Ashira; Nick, Todd G.

doi:10.1111/j.1553-2712.2004.tb01369.x

Cited by 160 publications

(165 citation statements)

References 22 publications

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“…We can only speculate as to whether larger numbers would have led to the effect of ED closure ( p ϭ 0.054) to reach statistical significance. Other observations from the model are consistent with findings by Weiss et al, who found that the number of patients admitted through the ED and ambulance traffic, but not nurse staffing levels, correlate with throughput times (10). Finally, we did not address how long the subjects had been waiting, or perceived they had been waiting, before completing their interview.…”

Section: Limitationssupporting

confidence: 78%

Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed

Walsh

Cortez

Bhakta

2008

The Journal of Emergency Medicine

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Boarding of admitted patients in the Emergency Department (ED), rather than in inpatient care areas, is widespread. We surveyed boarded patients, patients without a disposition, and visitors at a county hospital ED serving a mixed urban and rural population. Subjects were asked "If you needed to be admitted to the hospital but no inpatient bed is available, would you prefer to be kept in an ER hallway or a hallway on an inpatient ward?" Boarded patients said they would prefer ward to ED boarding, 117/213 (54.9%; 95% confidence interval [CI] 48.0%-61.7%). Patients without a disposition 314/477 (65.8%; 95% CI 61.4%-70.0%) and visitors 370/532 (69.5%; 95% CI 65.4%-73.4%) stated a preference for ward boarding in 314/477 (65.8%; 95% CI 61.4%-70.0%) and in 370/532 (69.5%; 95% CI 65.4%-73.4%), respectively. Common reasons for preferring inpatient ward boarding were privacy concerns and reduced noise levels. Those preferring ED boarding valued easy access to a doctor.

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Section: Limitationssupporting

confidence: 78%

Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed

Walsh

Cortez

Bhakta

2008

The Journal of Emergency Medicine

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“…These include the current number of ED patients, the number of ED beds, the number of inpatient beds, the last door-to-bed time, the longest admit time, and the number of critical care patients in the ED. The corresponding formula, as developed by Weiss et al (2004), is:…”

Section: Ed Overcrowdingmentioning

confidence: 99%

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Davis

Zobel

Khansa

et al. 2019

J of Ops Management

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Overcrowding poses a serious challenge to the operations of health care facilities, especially those with a mandate to provide emergency care. A better understanding of emergency department (ED) performance during disaster‐level overcrowding is a key to increasing a facility's resilience, optimizing patient outcomes, and more effectively allocating resources. With this in mind, this study quantitatively examines the extent to which different factors contribute to the resilience of hospital EDs during disaster‐level overcrowding events. A modeling framework was developed in collaboration with the Carilion Clinic ED, a level one trauma center in Virginia. The testing and analysis of the approach is based on data from actual disaster‐level overcrowding events that occurred in the Spring of 2016. Results indicate that by considering not only the capacity for resisting such events but also the capacity for recovering from them more quickly, hospital decision makers can improve both their operational effectiveness and the patient experience. Furthermore, by using our framework to identify precipitating factors and predict severe overcrowding, hospital decision makers can implement changes to improve the future resilience of their ED to such overcrowding events.

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“…Seventy-two percent of patients reported at least one positive PTSD symptom at 30 days (defined as a score of 2 or more on at least one PCL-5 question), and 25% reported clinically significant PTSD symptoms (defined as scored 2 or more on at least one B item [questions 1-5], one C item [questions 6 and 7], two D items [questions [8][9][10][11][12][13][14], or two E items [questions [15][16][17][18][19][20] or a total score greater than 32). 19,20 Among the entire cohort the median (IQR) PCL-5 score was 7 (0 to 30).…”

Section: Resultsmentioning

confidence: 99%

“…For each patient, we also recorded comorbid conditions (i.e., Charlson comorbidity index), 16 presenting vital signs in the ED, severity of illness (i.e., Acute Physiologic Assessment and Chronic Health Evaluation [APACHE] II score), 17 and all therapeutic interventions initiated in the ED, as well as ED length of stay and ED crowding using the National Emergency Department Overcrowding Study (NEDOCS) tool. 18…”

Section: Data Collectionmentioning

confidence: 99%

Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies

Moss

Roberts

Shea

et al. 2019

Academic Emergency Medicine

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Background Our objectives were to test whether during a potentially life‐threatening medical emergency, perceived threat (a patient’s sense of life endangerment) in the emergency department (ED) is common and associated with the subsequent development of posttraumatic stress disorder (PTSD) symptoms. Methods This study was an ED‐based prospective cohort study in an academic hospital. We included adult patients requiring acute intervention in the ED for resuscitation of a potentially life‐threatening medical emergency, defined as respiratory or cardiovascular instability. We measured patient‐perceived threat in the ED using a validated patient self‐assessment measure (score range = 0 to 21, with higher scores indicating greater perceived threat). We performed blinded assessment of PTSD symptoms 30 days after discharge using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders‐Fifth Edition (PCL‐5). Results Ninety‐nine of 113 (88%) patients completed follow‐up, with 98% reporting some degree of perceived threat, median (interquartile range [IQR]) perceived threat score 12 (6 to 17), and 72% reported PTSD symptoms in relation to their ED visit (median [IQR] PCL‐5 score = 7 [0 to 30]). Patients with respiratory instability had higher median (IQR) perceived threat scores (16 [9 to 18] vs. 9 [6 to 14)] and PCL‐5 scores (10 [2 to 40] vs. 3 [0 to 17]) compared to patients without respiratory instability. In a multivariable linear regression model adjusting for potential confounders, greater perceived threat in the ED was independently associated with higher PCL‐5 scores (β = 0.79, 95% confidence interval [CI] = 0.15 to 1.42). Among the individual perceived threat items, the feeling of helplessness during resuscitation had the strongest association with PCL‐5 score (β = 5.24, 95% CI = 2.29 to 8.18). Conclusions Perceived threat during potentially life‐threatening emergencies is common and independently associated with development of PTSD symptoms. Additional research to test whether reduction of perceived threat in the ED attenuates the development of PTSD symptoms following potentially life‐threatening emergencies is warranted.

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Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Results of the National ED Overcrowding Study (NEDOCS)

Cited by 160 publications

References 22 publications

Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed

Patients Would Prefer Ward to Emergency Department Boarding While Awaiting an Inpatient Bed

Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies

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