Weiss Steven J, Ernst Amy A, Sills Marion R, Quinn Bruce J, Johnson Ashira, Nick Todd G
University of New Mexico Medical Center, Albuquerque, NM 87131-0001, USA.
Pediatr Emerg Care. 2007 Sep;23(9):641-5. doi: 10.1097/PEC.0b013e31814a69e2.
Emergency department (ED) overcrowding has been quantified with a scale that reflects the degree of overcrowding (National ED Overcrowding Scale, or NEDOCS) in general academic EDs. However, validity of the 5-question NEDOCS scale has not been established for a pediatric ED. Our primary objectives were to validate the NEDOCS model in our institution's pediatric ED and explore the possibility of another pediatric ED overcrowding model that would be better than the NEDOCS model.
Objective data were determined by prospectively collecting 20 variables at 42 random site-sampling times in one pediatric ED. Data were obtained by counting patients, determining patient's times, and obtaining information from registration, triage, and ancillary services. The 5 questions needed for the NEDOCS scale were among the data collected. Expert consensus (EC) was obtained using a Likert scale completed by the charge nurse and ED physicians who rated the degree of overcrowding. National ED Overcrowding Scale scores were compared with EC score to determine predictive validity of a model for a pediatric ED. Spearman correlation and multivariable linear regression were used to evaluate individual variables.
Overcrowding based on EC score was found in 18 (44%) of 41 times in the pediatric ED. In pediatric EDs, high correlations were found between EC score and NEDOCS (0.68), number of patients in the waiting room (0.74), full rooms (0.64), and total registered patients (0.65). In a multivariable analysis, a combination of patients in the waiting room and total registered patients had a high correlation (0.80) with EC score in the pediatric ED.
Overcrowding is quantifiable in a pediatric ED. Although the NEDOCS performed well in the pediatric ED, it was outperformed by other variables and other variable combinations. In this pediatric ED, a combination of 2 variables, total registered patients and patients in the waiting room, was a better model than the NEDOCS score for quantifying pediatric ED overcrowding.
急诊部（ED）过度拥挤情况已通过一种反映过度拥挤程度的量表（国家急诊部过度拥挤量表，即NEDOCS）在一般学术性急诊部进行了量化。然而，5个问题的NEDOCS量表在儿科急诊部的有效性尚未得到证实。我们的主要目标是在我们机构的儿科急诊部验证NEDOCS模型，并探索另一种比NEDOCS模型更好的儿科急诊部过度拥挤模型的可能性。
通过前瞻性地在一个儿科急诊部的42个随机现场采样时间收集20个变量来确定客观数据。通过对患者进行计数、确定患者停留时间以及从登记、分诊和辅助服务获取信息来获得数据。NEDOCS量表所需的5个问题包含在收集的数据中。使用由护士长和急诊医生完成的李克特量表获得专家共识（EC），他们对过度拥挤程度进行评分。将国家急诊部过度拥挤量表得分与EC得分进行比较，以确定儿科急诊部模型的预测有效性。使用Spearman相关性和多变量线性回归来评估各个变量。
在儿科急诊部的41次情况中，有18次（44%）发现基于EC得分的过度拥挤情况。在儿科急诊部，EC得分与NEDOCS（0.68）、候诊室患者数量（0.74）、满床数量（0.64）和总登记患者数量（0.65）之间存在高度相关性。在多变量分析中，候诊室患者和总登记患者的组合与儿科急诊部的EC得分具有高度相关性（0.80）。
儿科急诊部的过度拥挤情况是可量化的。虽然NEDOCS在儿科急诊部表现良好，但它被其他变量和其他变量组合超越。在这个儿科急诊部，总登记患者和候诊室患者这两个变量的组合在量化儿科急诊部过度拥挤方面是比NEDOCS得分更好的模型。
