ArticleBMC emergency medicine2022
A case study to investigate the impact of overcrowding indices in emergency departments.
Article in BMC emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Emergency department crowding in the modern era: a systematic review (2018-2025).Clinical and experimental emergency medicine · 2026Pooled it
- Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis.Scientific reports · 2024Pooled it
- Overcrowding Indicators in Emergency Departments Across Countries: Scoping Review.Interactive journal of medical research · 2026Review
- A pediatric emergency prediction model using natural language process in the pediatric emergency department.Scientific reports · 2025Article
- Predicting emergency department admissions using a machine-learning algorithm: a proof of concept with retrospective study.BMC emergency medicine · 2025Article
- Mini-Review: From measurement to prediction-a conceptual paradigm shift in assessing overcrowding in pediatric emergency departments since 2021.Frontiers in pediatrics · 2025Review
- Measuring the crowding of emergency departments: an assessment of the NEDOCS in Lombardy, Italy, and the development of a new objective indicator based on the waiting time for the first clinical assessment.BMC emergency medicine · 2024Article
- Perceived Causes and Effects of Overcrowding Among Nurses in the Emergency Departments of Tertiary Hospitals: A Multicenter Study.Risk management and healthcare policy · 2024Article
- Overcrowding analysis in emergency department through indexes: a single center study.BMC emergency medicine · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmergency department (ED) overcrowding is widespread in hospitals in many countries, causing severe consequences to patient outcomes, staff work and the system, with an overall increase in costs. Therefore, health managers are constantly looking for new preventive and corrective measures to counter this phenomenon. To do this, however, it is necessary to be able to characterize the problem objectively. For this reason, various indices are used in the literature to assess ED crowding. In this work, we explore the use of two of the most widespread crowding indices in an ED of an Italian national hospital, investigate their relationships and discuss their effectiveness.
methodsIn this study, two of the most widely used indices in the literature, the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Working Index (EDWIN), were analysed to characterize overcrowding in the ED of A.O.R.N. "A. Cardarelli" of Naples, which included 1678 clinical cases. The measurement was taken every 15 minutes for a period of 7 days.
resultsThe results showed consistency in the use of EDWIN and NEDOCS indices as measures of overcrowding, especially in severe overcrowding conditions. Indeed, in the examined case study, both EDWIN and NEDOCS showed very low rates of occurrence of severe overcrowding (2-3%). In contrast, regarding differences in the estimation of busy to overcrowded ED rates, the EDWIN index proved to be less sensitive in distinguishing these variations in the occupancy of the ED. Furthermore, within the target week considered in the study, the results show that, according to both EDWIN and NEDOCS, higher overcrowding rates occurred during the middle week rather than during the weekend. Finally, a low degree of correlation between the two indices was found.
conclusionsThe effectiveness of both EDWIN and NEDOCS in measuring ED crowding and overcrowding was investigated, and the main differences and relationships in the use of the indices are highlighted. While both indices are useful ED performance metrics, they are not always interchangeable, and their combined use could provide more details in understanding ED dynamics and possibly predicting future critical conditions, thus enhancing ED management.
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