The occurrence of overcrowding in the hospital emergency department (ED) is a major issue that causes problems such as excessive waiting times, decreased nurse efficiency and patient satisfaction, and poor quality of care. It is also associated with a high number of patients who are left without being seen (LWBS) and re-visits to the ED due to progressive worsening of their symptoms and/or death [1].
Overcrowding is generated by internal factors like bed availability and staff lack, as well as external ones such as increasing patient demand and complexity of conditions treated [2]. A precise measurement of overcrowding is essential to mitigate its negative impacts on hospitals, ED staff, and patient outcomes and satisfaction. The most effective way to do this is through the use of overcrowding estimation indices such as the NEDOCS and EDWIN, both based on the number of patients in each triage category.
In the present paper, the NEDOCS and EDWIN values registered in the ED of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital during two periods of time (one prior to the Covid-19 pandemic and one afterwards) are compared. The results indicate that the EDWIN index was able to effectively reproduce the overcrowding situation observed in the ED before and after the Covid-19 pandemic, suggesting a good validity of this method of overcrowding measurement.
In addition, a questionnaire about the nurses’ perceived cause and effect of overcrowding was developed; its reliability was tested by Cronbach’s alpha. The results indicate that the nurses attributed the most important reason for overcrowding to the need of taking additional patients due to an insufficient capacity to accommodate patients already in the ED and to the limited possibility of transferring them to other areas of the hospital.