Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Study (NEDOCS) in Tertiary Care Hospital to Measure Emergency Department Crowding

Abstract

Objective: To compare NEDOCS with ICMED in predicting clinicians' concerns regarding crowding in the Emergency Department of a tertiary care hospital in Pakistan. Study Design: Prospective comparative study. Place and Duration of Study: Accident & Emergency Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Jan 2022. Methodology: This study was conducted at the Accident and Emergency Department over 14 different days, 30 data sets of 3-hour intervals each were collected using the NEDOCS and ICMED proforma. NEDOCS Scores and ICMED scores were calculated. In addition, perceptions of the staff regarding crowding and danger to the patient's status were recorded on Visual Analogue scales. Results: The mean recorded NEDOCS score was 577.94±251.57, with 29 'extremely overcrowded' and 1 'overcrowded' data set. The mean ICMED score was 2.86±0.83. Twenty-four (80%) sets did not have crowding, with only six (20%) sets being categorized as 'crowded'. The NEDOCS score had a moderately positive correlation with the crowding perception of the staff (Correlation coefficient (r)=0.593). Conclusion: NEDOCS was a more suitable measure for recording ED crowding in Pakistan, as it recorded the quantitative component of waiting time. ICMED, on the other hand, only recorded waiting time on a binary scale, with the waiting time impact not translated fully on the total score.