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    Patent Pending

    CEDOCS Score for Emergency Department Overcrowding

    Estimates severity of overcrowding in community emergency departments.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Many EDs are using these scores every shift or at times on shift with drastic changes in crowding (large influx of patients, for example).

    • CEDOCS was created as an improved analysis over the NEDOCS scoring system; both assess and quantify ED overcrowding.
    • CEDOCS was developed specifically with community emergency departments in mind.
      • NEDOCS only targeted large, academic trauma centers.
    • Interestingly, its score was calibrated by comparing “busy-ness” to ratings by emergency physicians and emergency department charge nurses.
    • CEDOCS is calibrated to score 0-100, but usually the score is doubled so it can be compared to NEDOCS (0-200).
    • CEDOCS appears to be valid at EDs with at least 18,000 patients per year.

    Points to keep in mind:

    • These scores are “best guess” estimates to objectify over-crowding but will not always be able to account for all causes of over-crowding.
      • For example, as mentioned by its authors, “‘psych patients awaiting admission’ were not a problem in the particular hospitals in the original NEDOCS study but have become more of a recent problem in community-based hospitals.”

    Providing an objective, quantitative score can help EDs and their hospitals provide appropriate resources to the ED and rest of the hospital to reduce delays in care and boarding, which have been shown to have significant impacts on patient morbidity and mortality.

    beds
    visits/yr
    patients
    patients
    patients
    hours

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Perform a crowding score assessment every shift, as well as at times of large influxes of patients to the ED.

    Management

    Many hospitals have developed “surge plans” similar to disaster plans that provide additional resources to the hospital and ED when an ED goes above a certain score threshold (often level 4 or 5 - >100 or >140).

    Facts & Figures

    Score interpretation:

    Level Score Interpretation
    Level 1 1-20 Not busy
    Level 2 21-60 Busy
    Level 3 61-100 Extremely busy but not overcrowded
    Level 4 101-140 Overcrowded
    Level 5 141-180 Severely overcrowded
    Level 6 181-200 Dangerously overcrowded
    Dr. Steven Weiss

    About the Creator

    Steven Weiss, MS, MD FACP, FACEP, is a professor of medicine at University of New Mexico. He is presently the medical director of the Critical Care Transport Team for AAS. Dr. Weiss is the creator of both the CEDOCS, NEDOCS, and the more recent PEDOCS, and he is an avid researcher in Emergency Medicine, working towards ways to improve efficiency and efficacy of ED workflow.

    To view Dr. Steven Weiss's publications, visit PubMed