NEDOCS Calculator

Created by Mariamy Chrdileli
Reviewed by Łucja Zaborowska, MD, PhD candidate and Steven Wooding
Based on research by
Weiss et al. Estimating the Degree of Emergency Department Overcrowding in Academic Medical Centers: Result of the National ED Overcrowding Study (NEDOCS) Academic Emergency Medicine, 11: 38-50 (2004)
Last updated: Oct 27, 2022

Welcome to the Omni NEDOCS calculator, a convenient tool to assess emergency department (ED) overcrowding.

Overcrowding in an ED is a common problem in many countries; it decreases the quality of care and increases medical errors and mortality. To take corresponding actions toward resolving the issue, utilizing a standardized measuring method and assessing the impact of overcrowding is essential.

We designed this NEDOCS score calculator based on the Emergency Department Overcrowding Scale to help you improve the care of patients by objectively assessing factors that lead to crowding.

Read this article to get clear answers to NEDCOS-related questions such as:

  • What is the National Emergency Department Overcrowding Scale?
  • What is the NEDOCS formula?
  • How does the NEDOCS calculator work? And more!

The National Emergency Department Overcrowding Scale (NEDOCS)

Weiss and colleagues created the National Emergency Department Overcrowding Scale to measure the degree of overcrowding in emergency departments (ED). ED overcrowding is a phenomenon when, due to the excessive number of patients and limited space, medical professionals are unable to address the needs of upcoming patients requiring emergency care.

NEDOCS has seven variables:

  • Total number of beds in ED – Includes hallway stretchers, gurneys, chairs, fast track, and other treatment benches or beds in use or staffed. The variable does not include un-staffed beds.

  • Total number of beds in the hospital – Includes the total number of inpatient beds, holding beds, and observation beds.

  • Total number of patients in ED – All patients who have walked in the ED door and haven't been discharged; the variable includes those in the waiting rooms, regardless of their admission status.

  • Critical care patients – This variable encompasses patients on ventilators, ICU admits, trauma patients, and psych holds. Typically, this variable involves all patients requiring one-to-one nurse care. If you're interested in a tool that screens for the severity of injuries or assesses coma and state of consciousness, check out revised trauma score calculator and Glaslow coma scale calculator, respectively.

  • Total number of admits in the ED – Includes all holdovers, admits, and rollovers in the ED. Excludes patients transferred to inpatient holding areas.

  • Waiting time of longest waiting room patient – The amount of time in hours of an admitted patient who waited the longest in the ED for an inpatient bed.

  • Waiting time of last admitted patient – The number of hours it took for the last patient to receive a bed.

How do you calculate NENDOCS score? NEDOCS formula

Now that you know the meaning of NEDOCS, let's talk about its calculation. You can compute the NEDOCS score using the following formula:

overcrowding score  =  (85.8 × c/a) + (600 × f/b) + (13.4 × d) + (0.93 × e) + (5.64 × g) - 20,

where:

  • a – Total number of beds in the ED;
  • b – Total number of beds in the hospital;
  • c – Total number of patients in the ED;
  • d – Total number of critical care patients;
  • e – Waiting time of longest waiting room patient;
  • f – Number of admits in the ED; and
  • g – Waiting time of the longest admitted patient.

The result will indicate the degree of overcrowding in the ED. Keep reading to find out how to interpret the NEDOCS score, and visit MEWS score calculator to evaluate the mortality risk connected to your patients' state.

How do you interpret NEDOCS score?

Interpretation of the NEDOCS score is quite simple. After calculating the overcrowding index, all you have to do is compare the results to the given categories below:

Score

Interpretation

0 to 20

Not busy

21 to 60

Busy

61 to 100

Extremely busy but not overcrowded

101 to 140

Over-crowded

141 to 180

Severely over-crowded

181 and higher

Dangerously over-crowded

How does NEDOCS score calculator work?

Using the NEDOCS calculator is quite simple! All you have to do is accurately fill out seven given variables. By utilizing the NEDOCS formula, the NEDOCS calculator will determine whether your ED is not busy, busy, extremely busy but not overcrowded, over-crowded, severely overcrowded, or dangerously overcrowded.

FAQ

What does NEDOCS stand for?

NEDOCS stands for National Emergency Department Overcrowding Scale and is a standardized measure for evaluating the degree of emergency department (ED) overcrowding. ED overcrowding occurs when medical professionals cannot provide timely quality care due to an excessive number of incoming patients.

How do I count the total number of beds in ED in NEDOCS?

To count the total number of beds in the ED, you need to measure the total number following factors:

  1. Count the total number of gurneys.
  2. Check how many chairs there are in the ED.
  3. Add up the number of fast track and other treatment benches or beds.

Note that you should only count in-use or staffed places, not un-staffed beds.

What other scales than NEDOCS assess emergency department overcrowding?

Several scales similar to NEDOCS assess emergency department (ED) overcrowding, including:

  • Emergency Department Crowding Scale (EDCS) – Indicators assessed through EDCS are the number of ED physicians, ED and inpatient staffed beds, intensive care unit (ICU) and ED patients, and hospital occupancy rate.

  • Real-time Emergency Analysis of Demand Indicator (READI) – READI consists of three indicators assessing overcrowding: the bed ratio, the acuity ratio (the magnitude of medical need and services provided), and the provider ratio (current ED patients, arrival rates, and physicians’ capacity to move patients through the ED).

What does a score of 101 mean in NEDOCS?

A score of 101 in NEDOCS means that the emergency department (ED) is overcrowded. Note that any score above 141 indicates that ED is severely overcrowded, which may result in decreased quality of care and increased mortality rate.

Mariamy Chrdileli
Total number of beds in ED
Total number of beds in the hospital
Total number of the patients in ED
Critical care patients
Number of admits in the ED
Waiting time of the last admitted patient
hrs
Waiting time of longest waiting room patient
hrs
NEDOCS score
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