Assistenza infermieristica e ricerca : AIR · 2026
[Improving emergency department overcrowding measurement: local recalibration of the NEDOCS index and integration into the overcrowding management. A retrospective validation study for 2024-2025].
СтатьяВалидационное исследованиеНаблюдательное исследованиеАннотация на английскомНазвание и аннотация: Перевод в очереди
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Vacchelli Roberta, Tedino Giuseppe, Bacchiarello Valentina, Boccuzzi Adriana, Di Gioia Salvatore, Minniti Davide, Finiguerra Ivana, Conti Alessio
Аннотация
UNLABELLED: Improving Emergency Department overcrowding measurement: local recalibration of the NEDOCS index and integration into the overcrowding management plan. A retrospective validation study for 2024-2025.
INTRODUCTION: The NEDOCS (National Emergency Department Overcrowding Study) is the most widely used overcrowding index; validated in large US academic emergency departments, it tends to saturate in medium small European settings, classifying most ordinary days as critical.
OBJECTIVE: To describe the local recalibration of NEDOCS in a Piedmont hospital university trust and to assess its agreement and discriminative ability compared with the regional three level system.
METHODS: A retrospective observational study was conducted on 731 consecutive days (years 2024-2025), with point measurements taken at 10:00 a.m. Agreement was assessed using percentage agreement and weighted Cohen's kappa; discriminative ability was evaluated through ROC curves, deriving cut offs on 2024 data and validating them on 2025.
RESULTS: Over the two year period, days with severe overcrowding increased from 22 to 73. The original NEDOCS produced very high scores (median 287 and 310), flagging almost every day as severely overcrowded; the recalibrated index brought values back within the thresholds of the regional plan (median 130.5 and 143), ranking days by severity almost identically (rho = 0.90). Agreement with the Level declared by the bed manager was 65.1% (99.6% within one class; weighted kappa 0.63). The index showed good ability to identify overcrowded days (AUC 0.86 and 0.84) and excellent ability to identify severely overcrowded days (0.93 and 0.95).
CONCLUSIONS: Local recalibration restores the practical usefulness of NEDOCS. Adding a lower threshold as an early warning alert could support timely activation of interventions, whose monitoring is primarily entrusted to nurses.
INTRODUCTION: The NEDOCS (National Emergency Department Overcrowding Study) is the most widely used overcrowding index; validated in large US academic emergency departments, it tends to saturate in medium small European settings, classifying most ordinary days as critical.
OBJECTIVE: To describe the local recalibration of NEDOCS in a Piedmont hospital university trust and to assess its agreement and discriminative ability compared with the regional three level system.
METHODS: A retrospective observational study was conducted on 731 consecutive days (years 2024-2025), with point measurements taken at 10:00 a.m. Agreement was assessed using percentage agreement and weighted Cohen's kappa; discriminative ability was evaluated through ROC curves, deriving cut offs on 2024 data and validating them on 2025.
RESULTS: Over the two year period, days with severe overcrowding increased from 22 to 73. The original NEDOCS produced very high scores (median 287 and 310), flagging almost every day as severely overcrowded; the recalibrated index brought values back within the thresholds of the regional plan (median 130.5 and 143), ranking days by severity almost identically (rho = 0.90). Agreement with the Level declared by the bed manager was 65.1% (99.6% within one class; weighted kappa 0.63). The index showed good ability to identify overcrowded days (AUC 0.86 and 0.84) and excellent ability to identify severely overcrowded days (0.93 and 0.95).
CONCLUSIONS: Local recalibration restores the practical usefulness of NEDOCS. Adding a lower threshold as an early warning alert could support timely activation of interventions, whose monitoring is primarily entrusted to nurses.