| OBJECTIVES: Implement the National Emergency Department Overcrowding Score (NEDOCS) in an academic emergency department (ED) in order to quantify crowding severity, analyze ambulance diversion (AD) practices, and develop an objective AD protocol.;METHODS: The project took place in an academic ED with a yearly patient census of 80,000. The NEDOCS was implemented in the electronic medical record system and crowding scores were calculated every 30 minutes over a 2-month period between April 1, 2017 and May 31, 2017. A total of 2,923 scores were collected for analysis. Ambulance diversion rates were also analyzed and correlated with a NEDOCS score at the time of each AD activation. The NEDOCS was used to develop an AD protocol and the protocol was simulated using the same 2-month dataset to determine its effects on time spent on AD compared to current practices. RESULTS: The ED was found to be dangerously or disastrously overcrowded almost a quarter of the time (22.8%). Tuesday was the most crowded day of the week and demonstrated the most minutes on AD. Sunday was the least crowded day of the week, with the lowest AD rates. Multiple regression revealed crowding severity was significantly correlated to time spent on AD. A paired samples t-test demonstrated a statistically significant reduction in time on AD (26.8 minutes/day) with simulation of the AD protocol compared to current AD practices.;CONCLUSIONS: The NEDOCS was found to be significantly correlated with AD rates and is recommended to guide AD practices. The AD protocol simulation demonstrated successful reduction in time on AD. Implementation of the protocol is endorsed to reduce time spent on AD, improve resource utilization, and promote patient safety, ensuring AD is activated during severely crowded conditions and is avoided when the ED is not overcrowded. Interventions to address the root causes of ED crowding, including boarding of admitted patients in the ED, are also recommended to, ultimately, reduce the need for AD. |
