Document Detail

Measuring and forecasting emergency department crowding in real time.
MedLine Citation:
PMID:  17391809     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: We quantified the potential for monitoring current and near-future emergency department (ED) crowding by using 4 measures: the Emergency Department Work Index (EDWIN), the National Emergency Department Overcrowding Scale (NEDOCS), the Demand Value of the Real-time Emergency Analysis of Demand Indicators (READI), and the Work Score. METHODS: We calculated the 4 measures at 10-minute intervals during an 8-week study period (June 21, 2006, to August 16, 2006). Ambulance diversion status was the outcome variable for crowding, and occupancy level was the performance baseline measure. We evaluated discriminatory power for current crowding by the area under the receiver operating characteristic curve (AUC). To assess forecasting power, we applied activity monitoring operating characteristic curves, which measure the timeliness of early warnings at various false alarm rates. RESULTS: We recorded 7,948 observations during the study period. The ED was on ambulance diversion during 30% of the observations. The AUC was 0.81 for the EDWIN, 0.88 for the NEDOCS, 0.65 for the READI Demand Value, 0.90 for the Work Score, and 0.90 for occupancy level. In the activity monitoring operating characteristic analysis, only the occupancy level provided more than an hour of advance warning (median 1 hour 7 minutes) before crowding, with 1 false alarm per week. CONCLUSION: The EDWIN, the NEDOCS, and the Work Score monitor current ED crowding with high discriminatory power, although none of them exceeded the performance of occupancy level across the range of operating points. None of the measures provided substantial advance warning before crowding at low rates of false alarms.
Nathan R Hoot; Chuan Zhou; Ian Jones; Dominik Aronsky
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural     Date:  2007-03-27
Journal Detail:
Title:  Annals of emergency medicine     Volume:  49     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-06-14     Revised Date:  2008-02-07    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  747-55     Citation Subset:  AIM; IM    
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. <>
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MeSH Terms
Bed Occupancy / statistics & numerical data
Data Collection / methods*
Decision Support Techniques*
Emergency Service, Hospital / organization & administration,  utilization*
Models, Statistical
Patient Transfer / statistics & numerical data
Prospective Studies
ROC Curve
Reproducibility of Results
Sensitivity and Specificity
Workload / statistics & numerical data
Grant Support
LM07450-02/LM/NLM NIH HHS; R21 LM009002-01/LM/NLM NIH HHS; T32 GM07347/GM/NIGMS NIH HHS
Comment In:
Ann Emerg Med. 2008 Feb;51(2):212-3; author reply 213-4   [PMID:  18206557 ]
Erratum In:
Ann Emerg Med. 2007 Nov;50(5):534

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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