Patient Safety and Quality
Background: The future of emergency medicine lies not only in providing exceptional evidence based care but also in the assurance of a positive patient experience. The National Emergency Department Overcrowding Scale (NEDOCS) has been utilized as an analytical and predictive tool of emergency department resource stress. In recent years patient experience has become a primary focus within the healthcare industry. This study aims to determine if direct correlations exist between the overall NEDOCS, and each variable within it, to a patient’s experience. The authors hypothesize that as the NEDOCS increases, overall experience will be negatively impacted. This is novel research with no known prior direct comparison between these scoring systems.
Methods: A retrospective cohort study of discharged patients at an urban Level 1 Trauma Center who completed a third-party standardized patient experience survey over a 2-year period was completed. A Pearson correlation was used to analyze the association between NEDOCS and patient experience, using the survey component Likelihood to Recommend the emergency department (ED) as a measure of overall experience.
Results: A significant negative correlation was found between the overall NEDOCS and survey responses of Definitely Yes for Likelihood to Recommend (r=-0.11, p<0.01). Correlations with four of the five variables of NEDOCS showed similar significant negative correlations with patient experience: The total ED patients (r=-0.10, p=0.01), longest wait in the waiting room (r=-0.12, p<0.01), longest admit time (r=-0.09, p=0.02), and number of admitted patients (r=-0.13, p<0.001). As the number of each of these elements increased, the survey responses of Definitely Yes for Likelihood to Recommend decreased.
Conclusion: Resource stress, evident by the overall NEDOCS, as well as the individual elements, is associated with a poor ED experience as measured by Likelihood to Recommend. While efforts to decrease ED overcrowding can improve patient experience, a novel approach can utilize NEDOCS as an early warning system not only for overcrowding, but also for patient experience. As NEDOCS increases, ED leaders, providers, and caregivers should have a heightened awareness of the impact overcrowding has on the patient experience and initiate appropriate responses to mitigate this impact.