Measuring emergency department crowding: comparing the NEDOCS and Fenice crowding scores against staff perception

This study assesses the feasibility of collecting real-time perceptions of emergency department (ED) crowding from different professional roles and compares the recorded perceptions with two crowding indicators: the NEDOCS and the recently proposed Fenice score. We conducted a prospective observational study in an Italian university hospital. ED staff received two SMS questionnaires daily, assessing perceived crowding and workload pressure on 0-10 scales. Simultaneously, the NEDOCS and Fenice scores were recorded every 15 min. Spearman correlations, regression models, and generalized additive models were used to assess associations. Among 49 staff members, 830 valid on-shift responses were collected (response rate: 62.6%). Perceived crowding was generally high (median: 7; Q1-Q3: 5-9) and varied significantly by role (p-value < 0.001), with healthcare assistants and boarding nurses perceiving the ED as more crowded and process management nurses perceiving it as less crowded. The Fenice and NEDOCS scores correlated strongly with perceived crowding (ρ: 0.71 and 0.69; p value = 0.06) and moderately with workload pressure (ρ < 0.60). The Fenice score explained slightly more variance in perceived crowding (R<sup>2</sup>: 0.65 vs. 0.59). While the correlation between the two scores in the study ED was high (ρ: 0.85), a wide range of correlation coefficients emerged in a cohort of 83 Italian EDs (average ρ: 0.80; min-max: 0.24-0.99; Q1-Q3: 0.73-0.93). Real-time monitoring of ED staff perceptions is feasible and informative. Both the NEDOCS and Fenice scores correlate well with staff perception, but the simplicity and fully automatable implementation of the Fenice score make it a promising alternative to be evaluated in future studies.

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Journal
Internal and Emergency Medicine
Published
2025-12-12
DOI
https://doi.org/10.1007/s11739-025-04216-7
Primary Topic
Emergency and Acute Care Studies
Type
article
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article

Measuring emergency department crowding: comparing the NEDOCS and Fenice crowding scores against staff perception

Luis Filipe Torres Cruz de Lima, Salvatore Conte, Maureen Cosby, Leonardo Noto et al.
Internal and Emergency Medicine
Emergency and Acute Care Studies
article

Measuring emergency department crowding: comparing the NEDOCS and Fenice crowding scores against staff perception

Luis Filipe Torres Cruz de Lima, Salvatore Conte, Maureen Cosby, Leonardo Noto, Riccardo Boverio, Saverio Loddo, Guido Bertolini, Cristian Zanelli, Marianne Haenlein Alciati, Antonella Litta, Francesc Castelló, Carmen Dumitrescu, Dominique G. Costagliola, Mariana Isa Poci Palumbo, Giuliana Cangemi, Giulia Irene Ghilardi, Simona Gabriella Di Santo, Claudia Sossa, Alexandru Nistor, Giovanni Nattino, Carpio Cordero, Roberta Bellini, G Bruno, Carlotta Rossi, Laurence Caravella, Daniela Zatelli, Marcello Villanova, Richard G. Ferraro, Fabiola Signorini, Milan Del Buono, S Arcidiacono, Patrizia Boido, Carla Vigliano, Madalina Maria Amuntencei, Marco Bidoggia, Gianluca Cascina, Pietro Cerasa, Monica Doglio, Martina Fendoni, Anita Ferranti, Guido Gianluca, Chiara Macario, Victor Malatesti, Chiara Mattiazzo, Enrica Mensi, Francesca Minetti, Riccardo Morrone, Matteo Nocito, Iacoban Paraschiva, Cinzia Pareti, Vadis Pretato, Uberti Rana, Alessia Ri, Manuela Salera, Vincenzo Savino, Laura Tirri’, Elisabetta Vigutto, Lila Xesika, Giulia Zunino
article en

Abstract

This study assesses the feasibility of collecting real-time perceptions of emergency department (ED) crowding from different professional roles and compares the recorded perceptions with two crowding indicators: the NEDOCS and the recently proposed Fenice score. We conducted a prospective observational study in an Italian university hospital. ED staff received two SMS questionnaires daily, assessing perceived crowding and workload pressure on 0-10 scales. Simultaneously, the NEDOCS and Fenice scores were recorded every 15 min. Spearman correlations, regression models, and generalized additive models were used to assess associations. Among 49 staff members, 830 valid on-shift responses were collected (response rate: 62.6%). Perceived crowding was generally high (median: 7; Q1-Q3: 5-9) and varied significantly by role (p-value < 0.001), with healthcare assistants and boarding nurses perceiving the ED as more crowded and process management nurses perceiving it as less crowded. The Fenice and NEDOCS scores correlated strongly with perceived crowding (ρ: 0.71 and 0.69; p value = 0.06) and moderately with workload pressure (ρ < 0.60). The Fenice score explained slightly more variance in perceived crowding (R<sup>2</sup>: 0.65 vs. 0.59). While the correlation between the two scores in the study ED was high (ρ: 0.85), a wide range of correlation coefficients emerged in a cohort of 83 Italian EDs (average ρ: 0.80; min-max: 0.24-0.99; Q1-Q3: 0.73-0.93). Real-time monitoring of ED staff perceptions is feasible and informative. Both the NEDOCS and Fenice scores correlate well with staff perception, but the simplicity and fully automatable implementation of the Fenice score make it a promising alternative to be evaluated in future studies.

Internal and Emergency Medicine
Mario Negri Institute for Pharmacological Research (IT), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT)
Openalex Percentile: Top 44%
Emergency and Acute Care Studies
DOIOpen Access PDFOpenAlex
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