NEDOCS Calculator
National Emergency Department Overcrowding Scale - Assess ED capacity and patient flow
Healthcare Administration Tool
This calculator is designed for healthcare administrators and emergency department staff to assess overcrowding. Results should be used in conjunction with clinical judgment and institutional protocols. Always follow your facility's emergency protocols and escalation procedures.
Calculate NEDOCS Score
Include hallway stretchers, gurneys, chairs, fast track beds (staffed only)
Include inpatient beds, holding beds, and observation beds
All patients who entered ED and haven't been discharged (including waiting room)
Patients on ventilators, ICU admits, trauma patients, psych holds (1:1 nursing care)
Holdovers, admits, and rollovers waiting for inpatient beds
Time the longest-waiting patient has been waiting for care
Time it took for the last admitted patient to get an inpatient bed
NEDOCS Score Results
Clinical Interpretation
High patient volume but manageable capacity
Recommended Actions:
- •Monitor patient flow closely
- •Ensure adequate staffing
- •Prepare for potential overcrowding
- •Optimize discharge processes
- •Maintain communication with inpatient units
- •Consider fast-track protocols
NEDOCS Formula
a = ED Beds, b = Hospital Beds, c = Patients in ED
d = Critical Care Patients, e = Longest Wait Time, f = Admits in ED, g = Last Admitted Wait Time
Example Case
Case: Busy Emergency Department
Hospital: 300-bed community hospital
ED Parameters:
- • ED Beds: 25
- • Hospital Beds: 300
- • Total Patients in ED: 35
- • Critical Care Patients: 4
- • Admits in ED: 8
- • Longest Waiting Time: 3.5 hours
- • Last Admitted Wait Time: 2.0 hours
NEDOCS Calculation
(85.8 × 35/25) + (600 × 8/300) + (13.4 × 4) + (0.93 × 3.5) + (5.64 × 2.0) - 20
= 120.12 + 16.0 + 53.6 + 3.26 + 11.28 - 20
NEDOCS Score: 184.3 (Dangerously Overcrowded)
NEDOCS Scale Interpretation
Not Busy
Optimal conditions
Busy
Normal operations
Extremely Busy
High volume
Overcrowded
Affecting care
Severely Overcrowded
Significant impact
Dangerously Overcrowded
Crisis situation
Key NEDOCS Variables
ED Capacity
Total beds, gurneys, chairs (staffed)
Patient Volume
All patients in ED (including waiting)
Critical Care Load
High-acuity patients requiring 1:1 care
Boarding Issues
Admitted patients waiting for beds
Wait Times
Patient flow and bed availability
Clinical Applications
Quality Improvement
Identify bottlenecks and inefficiencies
Resource Allocation
Staffing and bed management decisions
Safety Monitoring
Early warning system for patient safety
Benchmarking
Compare performance across time periods
Understanding NEDOCS (National Emergency Department Overcrowding Scale)
What is NEDOCS?
NEDOCS is a validated tool developed by Weiss et al. to objectively measure emergency department overcrowding using seven key operational variables. It provides a standardized way to assess ED capacity and trigger appropriate interventions.
Clinical Significance
- •Standardized measure of ED overcrowding
- •Early warning system for patient safety risks
- •Guide for resource allocation and staffing decisions
- •Quality improvement and benchmarking tool
Formula Components
NEDOCS = (85.8 × c/a) + (600 × f/b) + (13.4 × d) + (0.93 × e) + (5.64 × g) - 20
Patient Density: 85.8 × (Patients/ED Beds)
Boarding Rate: 600 × (Admits/Hospital Beds)
Critical Care: 13.4 × Critical Patients
Waiting Time: 0.93 × Longest Wait
Bed Delay: 5.64 × Admit Wait Time
Validation: Developed using data from 21 EDs
Reliability: ICC = 0.96, strong inter-rater agreement
Implementation Guidelines
Score 0-60
Continue routine operations with standard monitoring
Score 61-140
Increase monitoring frequency and prepare for interventions
Score >140
Activate overcrowding protocols and emergency interventions