P2.E092: Comparison of two pediatric overcrowding scores in a pediatric emergency department

Background: A validated national emergency department overcrowding score (NEDOCS) has been implemented in emergency departments to signal crowding and trigger improved throughput. A pediatric emergency department overcrowding score (PEDOCS) has not been validated. This study attempts to determine the validity of the PEDOCS and to compare the accuracy of a pediatric NEDOCS (pNEDOCS) and PEDOCS at a tertiary children’s emergency department.

Methods: This was a prospective survey study conducted between July 12, 2023 and January 15, 2024, comparing provider impression of crowding with two overcrowding scores. The study took place in a children’s academic emergency department with an annual volume of 30,000. There are 7 individual elements used to calculate the pNEDOCS. The non-validated PEDOCS includes only two elements. These two scores were recorded by a charge nurse every 6 hours beginning at 6am. Simultaneously, attending physicians and the active charge nurse completed an electronically captured survey reflecting their sense of busyness (not busy, busy, extremely busy, overcrowded, severely overcrowded or critical) and the degree to which the provider felt rushed on a Likert scale of 1 to 5. Descriptive data included number of paired surveys with PEDOCS and pNEDOCS scores. Frequency of crowding levels were described for each score. Using the Spearman correlation coefficient, performance of PEDOCS and pNEDOCS were calculated and performance of PEDOCS vs pediatric NEDOCS were compared.

Results: There were 261 pNEDOCS values and 225 PEDOCS values. Survey responses and scores were included in the calculation only if they were paired (e.g., captured within 1 hour of each other). The mean pNEDOCS score was 76 (95%CI 70 to 82), the mean PEDOCS score was 36 (95%CI 32 to 39), and the mean composite linear score was 89 (95%CI 85 to 95). The pNEDOCS scores were classified as not busy (30.6%), busy (41%), overcrowded (17.6%), severely overcrowded (7.7%), and critical (3.0%). The PEDOCS scores were classified as not busy (30.0%), busy (56.9%), extremely busy (11.7%), and overcrowded (1.3%). The composite linear scores were classified as busy (36.0%), extremely busy (39.0%), overcrowded (16.5%), severely overcrowded (6.9%), and critical (1.5%). The Spearman correlation coefficient for pNEDOCS vs PEDOCS was 0.82, and for pNEDOCS vs composite linear score, it was 0.82, and for PEDOCS vs composite linear score, it was 0.79.

Conclusion: This study found that PEDOCS does not correlate as well with provider sense of crowding as does the pNEDOCS. Performance of either score at higher levels of crowding may need further investigation. Further validation of the newly proposed pNEDOCS should be performed at other pediatric institutions.