A New Crowding Indicator in the Emergency Department

Fenice has proposed a new indicator to measure the level of crowding in the ER. The aim of this study is to evaluate, in a national multicenter context, the degree of agreement between the Fenice indicator and the perception of crowding of the ER operators and to compare this agreement with that between NEDOCS and the perception of the operators.

The NEDOCS (National Emergency Department OverCrowding Study) is currently the most widely used indicator in Italy to measure the level of crowding in Emergency Departments (EDs). However, despite its widespread use, it presents several critical issues. First of all, it was developed in a context very different from the current Italian one, since it was built on data collected in 2002 in 8 medium-large US university EDs. It is therefore not possible to take for granted that this indicator can accurately describe the current crowding conditions of Italian EDs. Furthermore, the factors that make up the NEDOCS are often calculated differently by the various hospital facilities, compromising the comparability of the estimates. Fenice has proposed a new indicator to measure the level of crowding in EDs. The indicator was developed to measure one of the objective consequences of crowding in EDs, namely the increase in waiting time for patients with a problem classified as minor urgency or deferrable to triage (codes 3 and 4). In parallel, the Fenice study has shown that NEDOCS is not very sensitive to this objective consequence of crowding. The aim of this study is to evaluate, in a national multicenter context, the degree of agreement between the Fenice indicator and the perception of crowding of the operators of the ER and to compare this agreement with that between NEDOCS and the perception of the operators.