ED Overcrowding Validation Study

Study Overview
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Brief Summary
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The aim of this study is to externally validate a new emergency department overcrowding estimation tool (SONET) developed at John Peter Smith Health Network (JPS).

Detailed Description
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In recent years, emergency department (ED) overcrowding has become more and more common in regional and tertiary referral hospitals. ED overcrowding status significantly affects ED operational efficiency, resulting in ambulance diversion, increased ED 72h return visits, patient satisfaction, and left without being seen (LWBS) rates. Several estimation tools were derived to determine ED overcrowding status using various operational parameters such as, but not limited to, total number of ED patients, total ED admission holds, nursing staff, and patient injury severity. However, these tools cannot precisely evaluate ED overcrowding status, nor show strong correlations with ED operational inefficiency. The National Emergency Department Overcrowding Study (NEDOCS) is a widely used estimation tool to determine ED overcrowding status with relatively high consistency rates. However, the study was not able to evaluate interrater reliability since no standard definition of overcrowding existed. An ED overcrowding estimation tool, SONET, was developed and internally validated at JPS and showed more consistency and accuracy when compared to estimation rates utilizing NEDOCS. All things considered, it is worthwhile to perform a survey study to determine the interrater variability between different evaluators for an ED overcrowding evaluation tool, one utilizing all possible collectible operational variables. In order to minimize the bias and further determine the accuracy of evaluating ED overcrowding status, a multi-center external validation study is warranted. This study will extend to six sites for the purpose of externally validating JPS' novel ED overcrowding estimation tool, SONET, by comparing its overcrowding estimation rates with those derived utilizing NEDOCS.

Official Title
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A Validation Study of Emergency Department Crowding Estimation

Conditions
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Emergency Department Overcrowding

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all adult patients visiting the emergency department or urgent care clinic at any one of the six participating sites during the allocated one month time period Exclusion Criteria: those who do not meet inclusion criteria

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| JPS<br>study sample at JPS included for analysis | |
| BUMC Dallas<br>study sample at Baylor University Medical Center Dallas included for analysis | |
| BUMC at Gardin<br>study sample at Baylor University Medical Center Gardin included for analysis | |
| BUMC Waxahachie<br>study sample at Baylor University Medical Center Waxahachie included for analysis | |
| BUMC Carrolton<br>study sample at Baylor University Medical Center Carrolton included for analysis | |
| BUMC McKinney<br>study sample at Baylor University Medical Center McKinney included for analysis | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| left without being seen disposition chart review | LWBS refers to patients who have been called at least three times, using 20 minute intervals, to occupy an ED exam bed, however, do not respond. If after the third attempt the patient responds, the investigators will consider this a new patient registration/encounter. These data will be collected for each patient during the study period during initial ED registration and upon ED disposition. | 30 days | 
| emergency department 72 hour return chart review | ED 72h return will be defined to patients who re-register to the same ED as a new patient (unplanned) within 72h of a previous departure, regardless of the complaint. Planned ED revisits within 72h will be excluded. These data will be collected during initial ED registration during study period and will follow up each patient at least 72h post-discharge. | 30 days | 
| emergency department mortality |  | 30 days | 
| hospital mortality |  | 30 days | 
| emergency department length of stay |  | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient satisfaction survey | Patient satisfaction will be measured using Qualitick (Clearwater, FL), a real-time patient satisfaction program reporting tool using a Likert scale format. Patient will complete their Qualitick survey upon departure from ED regardless of their ED dispositions (e.g. transfer to inpatient service, discharge to home, transfer to another facility, etc.). Patients, or patient designees, will use a tablet to answer a series of questions. Patients, or their designees, have the option of omitting their name to ensure their information is kept anonymous. | 30 days | 
| physician empathy scale | Jefferson Physician Empathy Scale, available online, will be conducted by ED staff and compared with 1) staff working different shifts with different levels of crowding; 2) the norms; 3) staff working a more balanced schedule (roughly equal numbers of day, evening, and night shifts); and 4) attending physicians versus nursing staff versus residents. Average scores will be used to determine any differences among groups. The measurement tool will be repeated 6-9 months later to determine whether dynamic changes have occurred and whether an association exists with respect to changes in operation efficiency as a function of relative ED crowding at the individual physician level during the study period. The investigators recognize that the inclusion of the psychometric tests will be, to some extent, exploratory and the most important assessment will be the simple descriptive display of the mean scores (and standard deviations). | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multicenter study, emergency department, overcrowding status, estimation tool, validation