Emergency department operations
National Emergency Department Overcrowding Score (NEDOCS)
NEDOCS quantifies ED overcrowding based on patient load, boarding burden, and throughput delays. Update the inputs with current department metrics to generate the score and operational band.
Includes patients in beds, hallways, and waiting room currently being managed by ED staff.
Count actual, usable treatment spaces (stretcher chairs etc.).
Patients admitted to inpatient services but still physically in the ED.
Duration the longest-boarding admitted patient has been waiting for an inpatient bed.
Number of patients requiring ventilatory support being managed by ED staff.
Individuals registered and waiting for triage or bed assignment.
Ratios & inputs
- Patients / Beds1.50
- Boarders / Beds0.27
- Longest admit (h)6
- Ventilated pts2
- Waiting room pts12
NEDOCS score
419
Continuous score (may exceed 200)
Operational disaster. Immediate hospital-wide surge response and regional notification recommended.
Review surge protocols, inpatient throughput, and staffing adjustments based on the crowding band.
How to Use This Calculator
Capture live operational data
Collect the current number of ED patients, admitted boarders, ventilated patients, and waiting room counts.
Enter metrics accurately
Use staffed bed counts and precise boarding times. Small changes can materially impact the score.
Trigger escalation plans
Align the crowding band with your department’s surge playbooks, including inpatient throughput initiatives and staffing notifications.
Formula
NEDOCS = 85.8 × (ED Patients ÷ ED Beds) + 600 × (Admitted Boarding ÷ ED Beds) + 13.4 × (Longest Admit Wait in hours) + 0.93 × (Ventilated Patients) + 5.64 × (Waiting Room Patients) − 20.
Score interpretation bands:
- 0–20: Not busy
- 21–60: Busy
- 61–100: Very busy
- 101–140: Overcrowded
- 141–180: Severely overcrowded
- >180: Disaster
Full Description
The National Emergency Department Overcrowding Score (NEDOCS) quantifies crowding and correlates with delays, ambulance diversion, and adverse events. It integrates patient volume, boarding burden, critical care load, and wait-room congestion into a single continuous index.
NEDOCS supports operational decision making, such as activating surge plans, requesting inpatient assistance, and communicating with hospital leadership. Limitations include reliance on manual data entry, sensitivity to outliers, and variability across institutions with different layouts or staffing models.
Frequently Asked Questions
How often should NEDOCS be updated?
Many EDs recalculate hourly or when significant census changes occur. Automating data capture improves reliability.
What if ED beds are temporarily closed?
Use the number of actively staffed treatment spaces, excluding closed rooms, to reflect true capacity.
Does NEDOCS apply to pediatric EDs?
Yes, but ensure inputs reflect pediatric-specific capacity and boarding dynamics. Some sites tailor thresholds.
How does NEDOCS compare with EDWIN or SONET scores?
NEDOCS is simpler to compute but may be less comprehensive than alternative metrics. Choose the system aligned with your governance framework.